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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.)

  • This publication is provided for historical reference only and the information may be out of date.

This publication is provided for historical reference only and the information may be out of date.

Appendix RDetailed Infection Table

Table R-1Infection rates for trial of labor versus elective repeat cesarean delivery

Author, yearStudy descriptionNFeverFever per 10,000Endometritis Chorio-amnionitisEndometritis or Chorio-amnionitis per 10,000Wound/OtherWound/Other per 10,000
Term gestational age
Eriksen, 19891Retrospective cohort military base139TOL: 4/71 (5.6%)
ERCD: 7/68 (10.2%) (p:NS)
TOL: 560
ERCD: 1020 (p:NS)
TOL: 2/71 (2.8%)
ERCD: 1/68 (1.5%) (p:NS)
TOL: 280
ERCD: 150
Not reported
Hook, 19972Prospective cohort level 1, 2, & 3 hospital included989Maternal fever
TOL: 38/492 (8%)
ERCD: 0/497 (0%) (p=<0.0002)
Maternal fever
TOL: 80
ERCD: 0 (p=<0.0002)
Not reportedNot reportedNot reportedNot reported
Loebel,20043Retrospective cohort community teaching hospital1,408Not reportedNot reportedNot reportedNot reported“Infection”
ERCD: 11/481 (1.9%)
VBAC 14/749 (2.3%)
TOL-CD 9/178 (5.1%) (p:NS)
Infection”
ERCD: 190
VBAC 230
TOL-CD 510 (p:NS)
Spong, 20074MFMU network cohort 19 university hospitals39,117Not reportedNot reportedTOL: 442/15,323 (2.9%)
ERCD no labor: 260/14,993(1.7 %)
ERCD + labor: 101/2721 (3.7%)
IRCD no labor 137/5002 (2.7%)
IRCD + labor: 54/1078 (5.0%)
TOL: 290
ERCD no labor: 170
ERCD + labor: 370
IRCD no labor 270
IRCD + labor: 500
Not reportedNot reported
Wen, 20045Retrospective cohort Canadian registry ICD-9 codes308,755Not reportedNot reportedNot reportedNot reported“Postpartum Infection”
TOL: 487/128,960 (0.38%)
ERCD: 837/179,795 (0.47%);
Adjusted odds ratio: 0.86 (0.77–0.97)
“Postpartum Infection”
TOL: 380
ERCD: 470
Adjusted odds ratio: 0.86 (0.77–0.97)
All gestational ages
Bais, 20016Prospective cohort Netherlands regional hospital252TOL: 16/184 (9%)
ERCD: 7/68 (10%)
TOL: 900
ERCD: 1000
Not reportedNot reportedNot reportedNot reported
Cahill, 20067Retrospective cohort 16 university & community hospitals6,619TOL: 329/5041 (6.52%)
ERCD: 294/1578(18.63 %)
TOL: 652
ERCD: 1863
Not reportedNot reportedNot reportedNot
reported
Durnwald, 20048Retrospective cohort university hospital768TOL: 27/522(5.2%)
VBAC: 7/344(2.0%)
TOL-CD: 20/178 (11.2%)
ERCD: 6/246 (2.4%)
TOL: 520
VBAC: 200
TOL-CD: 1120
ERCD: 240
Chorio- amnionitis
TOL: 31/522(5.9%)
VBAC: 18/344(5.2%)
TOL-CD: 13/178(7.3%)
ERCD: 0/246(0%)

Endometritis
TOL: 24/522 (4.6%)
VBAC: 7/344(2%)
TOL-CD: 17/178(9.6%)
ERCD: 5/246(2%)
Chorio- amnionitis
TOL: 590
VBAC: 520
TOL-CD: 730
ERCD: 0

Endometritis
TOL: 460
VBAC: 200
TOL-CD: 960
ERCD: 200
Not reportedNot reported
Flamm, 19949Prospective cohort 10 Kaiser hospital in California7,229TOL: 638/5022 (12.7%)
ERCD: 362/2208 (16.4%)
TOL: 1270
ERCD: 1640
Not reportedNot reportedNot reportedNot reported
McMahon, 199610Retrospective cohort population based longitudinal study Canada6,138TOL: 171/3424 (5.3%)
ERCD: 185/2889 (6.4%)
TOL: 530
ERCD: 640
Not reportedNot reportedWound
TOL 43/3424 (1.3%)
ERCD 63/2889 (2.2%)
Wound
TOL 130
ERCD 220
Phelan, 198711Prospective Cohort University hospital ≥ 2 prior CD only2,643Planned TOL 159/1,796 (8.9%)*
VBAC: 53/1465 (3.6%)
TOL-CD: 106/331 (32%)
No Planned TOL 163/847 (19.2%)
VBAC: 4/69 (5.8%)
ERCD: 56/314 (18%)
IRCD: 103/464 (22%)
Planned TOL 890*
VBAC: 360
TOL-CD: 320
No Planned
TOL 1920
VBAC: 580
ERCD: 1800
IRCD: 2200
Not reportedNot reportedNot reportedNot reported
Kugler, 200812Retrospective cohort Israel University grand multiparous1,102IRCD 10/328 (3%), TOL: 9/619(1.5%), VBAC: 1/155(0.6%)IRCD 300
TOL: 150
VBAC: 60
Amnionitis
IRCDa 4/328(1.2%)
TOL: 5/619 (0.8%), VBAC: 14/155 (9.0%)
Amnionitis
IRCDa 120
TOL: 80
VBAC: 900
Not reportedNot reported
Eglinton, 198413Retrospective cohort university hospital871VBAC: 6/240(2.5%)
TOL-CD: 27/136 (19.8%)
ERCD: 176/495 (35.5%)
VBAC: 250
TOL-CD: 1980
ERCD: 3550
Not reportedNot reportedNot reportedNot reported
Chauhan, 20011469Not reportedNot reportedTOL: 9/30 (30%)
ERCD: 7/39 (18%)
TOL: 300
ERCD: 1800
Wound
TOL: 8/30(27%)
ERCD: 3/39(8%)
Wound
TOL: 2700
ERCD: 800
Hibbard, 200115Prospective cohort university hospital2,450Not reportedNot reportedEndometritis
ERCD: 38/431 (8.8%)
TOL: 108/1,324 (8.2%)
VBAC: 31/908 (3.4%)
TOL-CD: 77/416 (18.5%)
Chorio- amnionitis
ERCD: 18/431 (4.2%)
TOL: 169/1,324 (12.8%)
VBAC: 102/908 (11.2%)
TOL-CD: 67/416 (16%)
Endometritis
ERCD: 880
TOL: 820
VBAC: 340
TOL-CD: 1850
Chorio- amnionitis
ERCD: 420
TOL: 1280
VBAC: 1120
TOL-CD: 1600
Not reportedNot reported
Martin, 198316Prospective cohort 2 university centers709Not reportedNot reportedEndometritis
VBAC: 1/101(1%)
TOL-CD: 7/61 (11.5%)
ERCD: 42/547 (7.7%)
TOL: 8/162 = 4.9%
Endometritis
VBAC: 100
TOL-CD: 1150
ERCD: 770
TOL: 490
Wound
VBAC: 0/101
TOL-CD: 3/61 (4.9%)
ERCD: 12/547 (2.2%)
Any TOL: 3/162 (1.9%)
Pulmonary:
VBAC: 5/101 (5%)
TOL-CD: 1/61 (1.6%)
ERCD: 31/547 (5.7%)
Other:
VBAC: 3/101 (3%)
TOL-CD: 2/61 (3.2%)
ERCD:36/547(6.6%)
Wound
VBAC: 0
TOL-CD: 490
ERCD: 220
Any TOL: 190
Pulmonary
VBAC: 500
TOL-CD: 160
ERCD: 570
Other:
VBAC: 300
TOL-CD: 320
ERCD: 660
*

p < .05;

includes both ERCD as well as emergency CD

Abbreviations: ERCD=elective repeat cesarean delivery; IRCD=indicated repeat cesarean delivery; NS=not significant; TOL=trial of labor; TOL-CD=trial of labor followed by a cesarean delivery; UTI=urinary tract infection; VBAC=vaginal birth after cesarean

References

1.
Eriksen NL, Buttino L Jr. Vaginal birth after cesarean: a comparison of maternal and neonatal morbidity to elective repeat cesarean section. Am J Perinatol. 1989;6(4):375–379. [PubMed: 2789534]
2.
Hook B, Kiwi R, Amini SB, Fanaroff A, Hack M. Neonatal morbidity after elective repeat cesarean section and trial of labor. Pediatrics. 1997;100(3 Pt 1):348–353. [PubMed: 9282704]
3.
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]
4.
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]
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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]
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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]
7.
Cahill AG, Stamilio DM, Odibo AO, et al. Is vaginal birth after cesarean (VBAC) or elective repeat cesarean safer in women with a prior vaginal delivery? Am J Obstet Gynecol. 2006;195(4):1143–1147. [PubMed: 16846571]
8.
Durnwald C, Mercer B. Vaginal birth after Cesarean delivery: predicting success, risks of failure. J Matern Fetal Neonatal Med. 2004;15(6):388–393. [PubMed: 15280110]
9.
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]
10.
McMahon MJ, Luther ER, Bowes WA Jr, Olshan AF. Comparison of a trial of labor with an elective second cesarean section.[see comment] N Engl J Med. 1996;335(10):689–695. [PubMed: 8703167]
11.
Phelan JP, Clark SL, Diaz F, Paul RH. Vaginal birth after cesarean. Am J Obstet Gynecol. 1987;157(6):1510–1515. [PubMed: 3425654]
12.
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]
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Eglinton GS, Phelan JP, Yeh S, Diaz FP, Wallace TM, Paul RH. Outcome of a trial of labor after prior cesarean delivery. J Reprod Med. 1984;29(1):3–8. [PubMed: 6708017]
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Chauhan SP, Magann EF, Carroll CS, Barrilleaux PS, Scardo JA, Martin JN Jr. Mode of delivery for the morbidly obese with prior cesarean delivery: vaginal versus repeat cesarean section. Am J Obstet Gynecol. 2001;185(2):349–354. [PubMed: 11518890]
15.
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]
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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]
Cover of Vaginal Birth After Cesarean: New Insights
Vaginal Birth After Cesarean: New Insights.
Evidence Reports/Technology Assessments, No. 191.
Guise JM, Eden K, Emeis C, et al.

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