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Guise JM, Eden K, Emeis C, et al. Vaginal Birth After Cesarean: New Insights. Rockville (MD): Agency for Healthcare Research and Quality (US); 2010 Mar. (Evidence Reports/Technology Assessments, No. 191.)

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Vaginal Birth After Cesarean: New Insights.

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Appendix QDetailed Transfusion/Hemorrhage Table

Table Q-1Transfusion rates for trial of labor versus elective repeat cesarean delivery among any gestational age studies

Author, yearStudy descriptionNBlood transfusionBlood Transfusion per 10,000HemorrhageHemorrhage Rate per 10,000
Term gestational age
Gregory, 20081Retrospective cohort
Low-risk = absence of maternal complications
High-risk = any maternal condition
ICD-9 codes
41,450Low-risk
TOL: 38/8292 (0.46%)
ERCD: 69/20,834 (0.33%)
High-risk
TOL: 25/3188 (0.78%)
ERCD: 84/9136 (0.92%)
Low-risk
TOL: 46
ERCD: 33
High-risk
TOL: 78
ERCD: 92
Low-risk
TOL: 196/8292 (2.36%)
ERCD: 142/2083
(6.82%)
High-risk
TOL: 104/3188 (3.26%)
ERCD: 144/9136 (1.57%)
Low-risk
TOL:236
ERCD: 682
High-risk
TOL:326
ERCD: 157
Loebel, 20042Retrospective
Cohort,
Community
Teaching
Hospital
1,408
TOL: 927
ERCD: 481
TOL: 12/927 (1.29%)
ERCD: 3/481 (0.62%)
TOL: 129
ERCD: 62
Not reportedNot reported
Spong 20073MFMU study19 Academic centers39,117TOL: 227/15,323 (1.48%)
ERCD: no labor:
138/14,993 (0.92%)
ERCD + labor: 45/2721 (1.65%)
IRCD no labor: 107/5002 (2.14%)
IRCD + labor: 23/1078 (2.13%)
TOL: 148
ERCD: no labor: 92
ERCD + labor: 165
IRCD no labor: 214
IRCD + labor: 213
Not reportedNot reported
Wen, 20044Retrospective cohort
Canadian
Registry
ICD-9 codes
308,755TOL: 245/128,960 (0.19%)
ERCD: 268/179,795 (0.15%), adjusted odds ratio 1.67 (1.39–2.00)
TOL: 19
ERCD: 15
adjusted odds ratio 1.67 (1.39–2.00)
Not reportedNot reported
Any gestational age
Bais, 20015Prospective Cohort Netherlands Regional hospital252TOL: 8/184 (4.35%)
ERCD: 4/68 (5.88%)
TOL: 435
ERCD: 588
Hemorrhage >500 mL
TOL: 31/184 (16.85%)
ERCD: 20/68 (29.41%)

Hemorrhage >1000 mL
TOL: 9/184 (4.89%)
ERCD: 6/68 (8.83%)
Hemorrhage >500 mL
TOL: 168.5
ERCD: 294.1

Hemorrhage >1000 mL
TOL: 489
ERCD: 8.83%
Flamm, 19946Prospective cohort 10 Kaiser Hospital in CA7229VBAC: 25/3516 (0.71%)
ERCD: 38/2208 (1.72%) (p=.0001)
VBAC: 71
ERCD: 172
(p=.0001)
Not reportedNot reported
Hibbard, 20017Prospective Cohort University Hospital2450ERCD: 6/431 (1.40%)
TOL: 11/1,324 (0.83%)
VBAC: 4/908 (0.44%)
TOL-CD: 7/416 (1.68%)
ERCD: 140
TOL: 83
VBAC: 44
TOL-CD: 168
>1,000mL
ERCD: 32/431 (7.42%)
TOL: 46/1,324 (3.47%)
VBAC: 7/908 (0.77%)
TOL-CD: 39/416 (9.37%)
>2,000mL
ERCD: 5/431 (1.16%)
TOL: 8/1,324 (0.60%)
VBAC: 3/908 (0.33%)
TOL-CD: 5/416 (1.20%)
>1,000mL
ERCD: 742
TOL:347
VBAC: 77
TOL-CD: 937
>2,000mL
ERCD: 116
TOL: 60
VBAC: 33
TOL-CD: 120
Kugler, 20088Retrospective cohort Israel University Grand Multiparous women1102ERCD: 18/328 (5.49%)
TOL: 8/155 (5.16%)
VBAC: 6/619 (1.0%)
p<0.001
ERCD: 549
TOL: 516
VBAC: 100
p<0.001
ERCD: 3/328 (0.91%),
TOL: 1/155 (0.64%),
VBAC: 5/619 (0.81%)
p <0.001
ERCD: 91
TOL: 64
VBAC: 81
p <0.001
Martin, 19839Prospective Cohort 2 University Centers709Not reportedNot reportedVBAC: 6/101 (5.94%)
TOL-CD: 9/61 (14.75%)
ERCD: 57/547 (10.42%)
VBAC: 594
TOL-CD: 1475
ERCD: 1042
McMahon, 199610Retrospective cohort Population based Longitudinal study Canada6,138TOL: 36/3429 (1.05%)
ERCD: 39/2889 (1.35%)
TOL: 105
ERCD: 135
Not reported
Obara, 199711Prospective Cohort University Hospital, Japan310Not reportedNot reportedERCD: 4/96 (4.17%)
TOL: 3/214 (1.40%)
ERCD: 417
TOL: 140

Abbreviations: CA=California; ERCD=elective repeat cesarean delivery; IRCD=indicated repeat cesarean delivery; MFMU=Maternal-Fetal Medicine Units Network; mL=milliliter; TOL=trial of labor; TOL-CD=trial of labor followed by a cesarean delivery; VBAC=vaginal birth after cesarean

References

1.
Gregory KD, Korst LM, Fridman M, et al. Vaginal birth after cesarean: clinical risk factors associated with adverse outcome. Am J Obstet Gynecol. 2008;198(4):452.e451–410. discussion 452.e410–452. [PubMed: 18395037]
2.
Loebel G, Zelop CM, Egan JFX, Wax J. Maternal and neonatal morbidity after elective repeat Cesarean delivery versus a trial of labor after previous Cesarean delivery in a community teaching hospital. J Matern Fetal Neonatal Med. 2004;15(4):243–246. [PubMed: 15280132]
3.
Spong CY, Landon MB, Gilbert S, et al. Risk of uterine rupture and adverse perinatal outcome at term after cesarean delivery. Obstet Gynecol. 2007;110(4):801–807. [PubMed: 17906012]
4.
Wen SW, Rusen ID, Walker M, et al. Comparison of maternal mortality and morbidity between trial of labor and elective cesarean section among women with previous cesarean delivery. Am J Obstet Gynecol. 2004;191(4):1263–1269. [PubMed: 15507951]
5.
Bais JM, van der Borden DM, Pel M, et al. Vaginal birth after caesarean section in a population with a low overall caesarean section rate. Eur J Obstet Gynecol Reprod Biol. 2001;96(2):158–162. [PubMed: 11384799]
6.
Flamm BL, Goings JR, Liu Y, Wolde-Tsadik G. Elective repeat cesarean delivery versus trial of labor: a prospective multicenter study. Obstet Gynecol. 1994;83(6):927–932. [PubMed: 8190433]
7.
Hibbard JU, Ismail MA, Wang Y, Te C, Karrison T. Failed vaginal birth after a cesarean section: how risky is it? I. Maternal morbidity. Am J Obstet Gynecol. 2001;184(7):1365–1371. discussion 1371–1363. [PubMed: 11408854]
8.
Kugler E, Shoham-Vardi I, Burstien E, Mazor M, Hershkovitz R. The safety of a trial of labor after cesarean section in a grandmultiparous population. Arch Gynecol Obstet. 2008;277(4):339–344. [PubMed: 17957377]
9.
Martin JN Jr, Harris BA Jr, Huddleston JF, et al. Vaginal delivery following previous cesarean birth. Am J Obstet Gynecol. 1983;146(3):255–263. [PubMed: 6859134]
10.
McMahon MJ, Luther ER, Bowes WA Jr, Olshan AF. Comparison of Q-4 a trial of labor with an elective second cesarean section.[see comment] N Engl J Med. 1996;335(10):689–695. [PubMed: 8703167]
11.
Obara H, Minakami H, Koike T, Takamizawa S, Matsubara S, Sato I. Vaginal birth after cesarean delivery: results in 310 pregnancies. J Obstet Gynaecol Res. 1998;24(2):129–134. [PubMed: 9631601]
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