Kaboré C., Chaillet N., Kouanda S., Bujold E., Traoré M., Dumont Alexandre. (2016). Maternal and perinatal outcomes associated with a trial of labour after previous caesarean section in sub-Saharan countries. BJOG : An International Journal of Obstetrics and Gynaecology, 123 (13), p. 2147-2155. ISSN 1470-0328.
Titre du document
Maternal and perinatal outcomes associated with a trial of labour after previous caesarean section in sub-Saharan countries
Kaboré C., Chaillet N., Kouanda S., Bujold E., Traoré M., Dumont Alexandre
Source
BJOG : An International Journal of Obstetrics and Gynaecology, 2016,
123 (13), p. 2147-2155 ISSN 1470-0328
Objective To assess the risks of uterine rupture, maternal and perinatal outcomes associated with a trial of labour (TOL) after one previous caesarean were compared with having an elective repeated caesarean section (ERCS) without labour in low-resource settings. Design A prospective 4-year observational study. Setting Senegal and Mali. Sample A cohort of 9712 women with one previous caesarean delivery. Methods Maternal and perinatal outcomes were compared between 8083 women who underwent a TOL and 1629 women who had an ERCS. Perinatal and maternal outcomes were then stratified according to the presence or absence of risk factors associated with vaginal birth after caesarean section. These outcomes were adjusted on maternal, perinatal and institutional characteristics. Main outcome measuresThe risks of uterine rupture, maternal complication and perinatal mortality associated with TOL after one previous caesarean as compared with ERCS, ResultsThe risks of hospital-based maternal complication [adjusted odds ratio (OR) 1.52; 95% CI 1.09-2.13; P = 0.013] and perinatal mortality (adjusted OR 4.53; 95% CI 2.30-9.92; P < 0.001) were significantly higher in women with a TOL compared with women who had an ERCS. However, when restricted to low-risk women, these differences were not significant (adjusted OR 0.90, 95% CI 0.55-1.46, P = 0.68, and adjusted OR 1.13; 95% CI 0.75-1.86; P = 0.53, for each outcome, respectively). Uterine rupture occurred in 25 (0.64%) of 3885 low-risk women compared with 70 (1.66%) of 4198 women with unfavourable risk factors. Conclusion Low-risk women have no increased risk of maternal complications or perinatal mortality compared with women with one or more unfavourable factors. Tweetable abstractLow-risk women have a lower risk of maternal complications or perinatal mortality compared with high-risk women. Tweetable abstract Low-risk women have a lower risk of maternal complications or perinatal mortality compared with high-risk women.
