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Vaginal Delivery After Caesarean Carries Dangers

Serious complications possible for women who try, study finds

THURSDAY, Feb. 5, 2004 (HealthDayNews) -- Women who have vaginal birth after having Caesarean deliveries are at increased risk for maternal morbidity and such serious complications as uterine rupture, endometriosis, transfusion or newborns who suffer brain injury from lack of oxygen, says a new study.

The four-year study, presented Feb. 5 at the Society for Maternal-Fetal Medicine's annual meeting in New Orleans, included about 46,000 women at 19 academic medical centers.

Of those women, approximately 16,000 underwent elective, repeat Caesarean delivery without labor and 18,000 women attempted vaginal birth after Caesarean delivery, known as a VBAC. About 12,000 women had other maternal or fetal indications for a repeat Caesarean delivery.

About 39 percent of the women decided to attempt vaginal delivery in spite of their previous Caesarean section. Of those women, 73 percent succeeded.

There were 128 (0.7 percent) cases of symptomatic uterine rupture, one of the major risks in such situations. Among infants whose mothers chose vaginal delivery, there were 13 cases of brain injury due to lack of oxygen -- hypoxic ischemic encephalopathy (HIE).

Eight of the 13 case of HIE, including two neonatal deaths, followed uterine rupture.

"While the magnitude of these risks is small, women who have had a previous Caesarean section and who are considering choices for childbirth should be aware of the level of risk involved," principal investigator Dr. Mark Landon, vice chairman of obstetrics and gynecology at Ohio State University Medical Center, says in a prepared statement.

"Overall, the risk for a serious newborn complication is approximately 1 in 2,000 trials of labor. At this level of risk, many women will continue to opt for an attempted VBAC," Landon says.

More information

Here's where you can learn more about VBAC.

SOURCE: Ohio State University, news release, Feb. 5, 2004
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