TY - JOUR
T1 - Evaluating Facility-Based Decision-Making in Women with a Prior Cesarean Delivery and Association with Maternal and Perinatal Outcomes
AU - Boatin, Adeline Adwoa
AU - Adu-Bonsaffoh, Kwame
AU - Wylie, Blair Johnson
AU - Obed, Samuel A.
N1 - Publisher Copyright:
© 2017, Springer Science+Business Media, LLC.
PY - 2017/9/1
Y1 - 2017/9/1
N2 - Objective To describe facility-based decision-making for women with one prior cesarean delivery (CD) in a resource-limited setting and to characterize maternal and perinatal outcomes in these groups. Methods One year retrospective study of women with one prior CD delivering at Korle-Bu Teaching Hospital (KBTH), Ghana. Women were categorized into three groups based on initial plan of management on admission [trial of labor after cesarean (TOLAC), emergency repeat CD (EMCD) or non-emergent repeat CD (RCD)]. Characteristics and outcomes across these groups were then compared. Results During the study period, 1247 women with one prior CD delivered at KBTH, of which 377 (30.2%) were triaged to RCD, 439 (35.2%) to EMCD and 431 (34.6%) to TOLAC. Twelve uterine ruptures and no maternal deaths occurred. Perinatal mortality was 4.2% (n = 52). Compared to the RCD group, the TOLAC group had a lower risk for maternal adverse events (aOR 0.3, 95% CI 0.1–1.0; p = 0.04) and non-significant higher risk of perinatal adverse events (aOR 1.6, 95% CI 0.7–3.3; p = 0.25). Compared to women triaged to RCD, the EMCD group had a non-significant increase in risk of maternal adverse events (aOR 1.6, 95% CI 0.8–3.5; p = 0.2) and a significantly higher rate of perinatal adverse events (aOR 2.4, 95% CI 1.2–4.9; p = 0.01). Conclusions for Practice Women triaged to EMCD at admission are different when compared to women allowed a TOLAC or offered a non-emergent RCD. These women bear increased rates of adverse outcomes and should be considered as a separate group for analysis in future studies conducted in similar settings.
AB - Objective To describe facility-based decision-making for women with one prior cesarean delivery (CD) in a resource-limited setting and to characterize maternal and perinatal outcomes in these groups. Methods One year retrospective study of women with one prior CD delivering at Korle-Bu Teaching Hospital (KBTH), Ghana. Women were categorized into three groups based on initial plan of management on admission [trial of labor after cesarean (TOLAC), emergency repeat CD (EMCD) or non-emergent repeat CD (RCD)]. Characteristics and outcomes across these groups were then compared. Results During the study period, 1247 women with one prior CD delivered at KBTH, of which 377 (30.2%) were triaged to RCD, 439 (35.2%) to EMCD and 431 (34.6%) to TOLAC. Twelve uterine ruptures and no maternal deaths occurred. Perinatal mortality was 4.2% (n = 52). Compared to the RCD group, the TOLAC group had a lower risk for maternal adverse events (aOR 0.3, 95% CI 0.1–1.0; p = 0.04) and non-significant higher risk of perinatal adverse events (aOR 1.6, 95% CI 0.7–3.3; p = 0.25). Compared to women triaged to RCD, the EMCD group had a non-significant increase in risk of maternal adverse events (aOR 1.6, 95% CI 0.8–3.5; p = 0.2) and a significantly higher rate of perinatal adverse events (aOR 2.4, 95% CI 1.2–4.9; p = 0.01). Conclusions for Practice Women triaged to EMCD at admission are different when compared to women allowed a TOLAC or offered a non-emergent RCD. These women bear increased rates of adverse outcomes and should be considered as a separate group for analysis in future studies conducted in similar settings.
KW - Antenatal care
KW - Emergency repeat cesarean delivery
KW - Intrapartum decision-making
KW - Repeat cesarean delivery
KW - Trial of labor after cesarean
KW - Vaginal birth after cesarean
UR - http://www.scopus.com/inward/record.url?scp=85023195583&partnerID=8YFLogxK
U2 - 10.1007/s10995-017-2302-3
DO - 10.1007/s10995-017-2302-3
M3 - Article
C2 - 28699093
AN - SCOPUS:85023195583
SN - 1092-7875
VL - 21
SP - 1845
EP - 1852
JO - Maternal and Child Health Journal
JF - Maternal and Child Health Journal
IS - 9
ER -