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Randomized Controlled Trial
. 2012;9(3):e1001192.
doi: 10.1371/journal.pmed.1001192. Epub 2012 Mar 13.

Planned vaginal birth or elective repeat caesarean: patient preference restricted cohort with nested randomised trial

Caroline A Crowther  1 , Jodie M Dodd, Janet E Hiller, Ross R Haslam, Jeffrey S Robinson; Birth After Caesarean Study Group
Collaborators, Affiliations
Randomized Controlled Trial

Planned vaginal birth or elective repeat caesarean: patient preference restricted cohort with nested randomised trial

Caroline A Crowther et al. PLoS Med. 2012.

Abstract

Background: Uncertainty exists about benefits and harms of a planned vaginal birth after caesarean (VBAC) compared with elective repeat caesarean (ERC). We conducted a prospective restricted cohort study consisting of a patient preference cohort study, and a small nested randomised trial to compare benefits and risks of a planned ERC with planned VBAC.

Methods and findings: 2,345 women with one prior caesarean, eligible for VBAC at term, were recruited from 14 Australian maternity hospitals. Women were assigned by patient preference (n = 2,323) or randomisation (n = 22) to planned VBAC (1,225 patient preference, 12 randomised) or planned ERC (1,098 patient preference, ten randomised). The primary outcome was risk of fetal death or death of liveborn infant before discharge or serious infant outcome. Data were analysed for the 2,345 women (100%) and infants enrolled. The risk of fetal death or liveborn infant death prior to discharge or serious infant outcome was significantly lower for infants born in the planned ERC group compared with infants in the planned VBAC group (0.9% versus 2.4%; relative risk [RR] 0.39; 95% CI 0.19-0.80; number needed to treat to benefit 66; 95% CI 40-200). Fewer women in the planned ERC group compared with women in the planned VBAC had a major haemorrhage (blood loss ≥ 1,500 ml and/or blood transfusion), (0.8% [9/1,108] versus 2.3% [29/1,237]; RR 0.37; 95% CI 0.17-0.80).

Conclusions: Among women with one prior caesarean, planned ERC compared with planned VBAC was associated with a lower risk of fetal and infant death or serious infant outcome. The risk of major maternal haemorrhage was reduced with no increase in maternal or perinatal complications to time of hospital discharge. Women, clinicians, and policy makers can use this information to develop health advice and make decisions about care for women who have had a previous caesarean.

Trial registration: Current Controlled Trials ISRCTN53974531

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Flow of participants in the study.
Data are numbers (%).
See this image and copyright information in PMC

Comment in

References

    1. Stone C, Halliday J, Lumley J, Brennecke S. Vaginal births after Caesarean (VBAC): a population study. Paediatr Perinat Epidemiol. 2000;14:340–348. - PubMed
    1. Cowan RK, Kinch RAH, Ellis B, Anderson R. Trial of labor following cesarean delivery. Obstet Gynecol. 1994;83:933–936. - PubMed
    1. Hamilton BE, Martin JA, J. VS. Births: preliminary data for 2007. Natl Vital Stat Rep. 2009;57:1–23. - PubMed
    1. Landon MB, Hauth JC, Leveno KJ, Spong CY, Leindecker S, et al. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. N Engl J Med. 2004;351:2581–2589. - PubMed
    1. Lydon-Rochelle M, Holt VL, Easterling TR, Martin DP. Risk of uterine rupture during labor among women with a prior cesarean delivery. N Engl J Med. 2001;345:3–8. - PubMed

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