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Comparative Study
. 2012 Apr;206(4):311.e1-9.
doi: 10.1016/j.ajog.2012.02.002.

Elective repeat cesarean delivery compared with spontaneous trial of labor after a prior cesarean delivery: a propensity score analysis

Sharon A Gilbert  1 , William A Grobman, Mark B Landon, Catherine Y Spong, Dwight J Rouse, Kenneth J Leveno, Michael W Varner, Steve N Caritis, Paul J Meis, Yoram Sorokin, Marshall Carpenter, Mary J O'Sullivan, Baha M Sibai, John M Thorp, Susan M Ramin, Brian M Mercer; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network
Collaborators, Affiliations
Comparative Study

Elective repeat cesarean delivery compared with spontaneous trial of labor after a prior cesarean delivery: a propensity score analysis

Sharon A Gilbert et al. Am J Obstet Gynecol. 2012 Apr.

Abstract

Objective: The purpose of this study was to determine outcomes, after the use of propensity score techniques, to create balanced groups according to whether a woman undergoes elective repeat cesarean delivery (ERCD) or trial of labor (TOL).

Study design: Women who were eligible for a TOL with 1 previous low transverse incision were categorized according to whether they underwent an ERCD or TOL. A propensity score technique was used to develop ERCD and TOL groups with comparable baseline characteristics. Outcomes were assessed with conditional logistic regression.

Results: The rates of endometritis, operative injury, respiratory distress syndrome, and newborn infant infection were lower and the rates of hysterectomy and wound complication were higher in the ERCD group.

Conclusion: Propensity score techniques can be used to generate comparable ERCD and TOL groups. Some types of maternal morbidity (such as hysterectomy) are higher; other types (such as operative injury) are lower in the ERCD group. Although the absolute risk is low, neonatal morbidity appears to be lower in the ERCD group.

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Figures

Figure 1
Figure 1
Flow chart illustrating the development of the study groups. LTCS, low transverse cesarean section; TOL, trial of labor; CD, cesarean delivery, CPD, cephalopelvic disproportion; FTP, failure to progress; ERCD, elective repeat cesarean delivery, VBAC, vaginal birth after cesarean
Figure 2
Figure 2
Distribution of the propensity scores, prior to matching, stratified by approach to delivery. TOL, trial of labor; ERCD, elective repeat cesarean delivery
Figure 3
Figure 3
Distribution of the propensity scores, after matching, stratified by approach to delivery. TOL, trial of labor; ERCD, elective repeat cesarean delivery
See this image and copyright information in PMC

References

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