Fetal and Neonatal Morbidity and Mortality Following Delivery After Previous Cesarean

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Mortality

The ability to provide accurate estimates of risk of death to the fetus in women contemplating a TOLAC versus ERCD is as important as providing patients with estimates of the risk of maternal death. Understanding the risk of death to the fetus in pregnancy and birth, regardless of mode of delivery, requires examining perinatal mortality and its subsets of fetal and neonatal mortality.

Perinatal mortality, which includes fetal and neonatal death up to 28 days,8 is of paramount concern when

Need for Resuscitation

A newborn’s first indication of well-being relies on his or her ability to transition at the time of delivery. Thus, the need for positive-pressure ventilation (or bag-and-mask ventilation) and the Apgar scores have often been used as surrogate outcome measures of perinatal morbidity. Three studies15, 18, 19 compared the frequency of bag-and-mask ventilation (BMV) in the neonate when women underwent TOLAC compared with ERCD. In the study by Kamath and colleagues,19 neonates delivered by ERCD

Summary

One and a half million women have cesarean deliveries in the United States each year, representing about a third of all births. The cost of these cesarean deliveries amounts to about $7.8 billion annually, almost half of the childbirth-related hospitalization expenses.2 The appropriate and safe use of cesarean and VBAC, therefore, is not only an individual patient and provider level concern but also one of national importance. The burgeoning number of primary cesarean deliveries only amplifies

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  • Cited by (9)

    • The Association between Hospital Frequency of Labor after Cesarean and Outcomes in California

      2020, Women's Health Issues
      Citation Excerpt :

      For instance, the positive associations between high LAC frequency and both infection and PPH are concerning, especially given the recent national policy focus on maternal morbidity and mortality (Creanga, Syverson, Seed, & Callaghan, 2017). When LAC is successful, it generally carries fewer risks than PRCDs (Cahill et al., 2006; Go et al., 2011; Guise et al., 2004; Guise et al., 2010; Macones et al., 2005). LAC resulting in unplanned cesarean delivery, however, represents the highest-risk scenario of the three groups (American College of Obstetricians and Gynecologists, 2017; Gregory et al., 2008).

    • Vaginal birth after cesarean: neonatal outcomes and United States birth setting

      2017, American Journal of Obstetrics and Gynecology
      Citation Excerpt :

      One in three pregnant women in the United States delivers her child via CD36; those who desire future fertility will face the decision to deliver via repeat CD or to seek TOLAC. Planned repeat CD and TOLAC each incur important risks to a pregnant or laboring woman,37,38 to her fetus or neonate,9 and to future children.8,37 Study results add to previous work that shows that a growing share of US women are choosing VBAC in out-of-hospital settings.6,28

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    Financial Disclosure: This work was funded by the Agency for Healthcare Research and Quality, Contract No. HHSA 290-2007-10057-I, Task order No. 4 for the Office of Medical Applications of Research at the National Institutes of Health.

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