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Gynaecologia et perinatologia : journal for gynaecology, perinatology, reproductive medicine and ultrasonic diagnostics, Vol. 13 No. 3, 2004.

Professional paper

DELIVERY AFTER CESAREAN SECTION

Frane Mikulandra
Tomislav Miletić
Eugenio Stoini
Jozo Anić
Mila Periša
Nelka Tomić

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Abstract

Objective. To examine deliveries of pregnant women with a previous cesarean delivery. Methods. Pregnant women were studied according to indications for cesarean section, age, interpregnancy interval, gestational age, trial of labor, delivery completion and perinatal mortality. Deliveries at 23 weeks’ gestation and newborn infants weighing 500 g were analyzed. Statistical analysis was performed using the 2-test with 2×2 contingency tables. The difference was considered to be significant at p<0.05. Results. Among 20766 singleton deliveries between January 1, 1983, and December 31, 2002, 1175 (5.66%) were cesareans. Of those 1175 women with cesarean section, 516 (43.8%) have had a previous cesarean delivery. In actual pregnancy 152 (29.5%) had elective repeat cesarean delivery, and 142 (27.5%) had emergency cesarean delivery. Vaginal delivery was attempted in 364 women: 289 (79.4%) had spontaneous onset of labor, 53 (14.6%) planned delivery, and 22 (6.0%) induced labor. Delivery was completed by cesarean section in 121 (41.9%) of 289 with spontaneous onset of labor, in 6 (11.3%) of 53 with planned delivery, and in 15 (68.2%) of 22 with induced labor (p<0.001) respectively. Uterine rupture was found in two women after delivery, whereas in one woman it was identified during delivery. Complication rates were lowest in women with attempted vaginal delivery (5.8%), then in women with elective repeat cesarean delivery (12.5%), whereas they were highest in women with emergency cesarean delivery (20.4%) (p<0.001). Late fetal death occurred in 1.16%, and early neonatal death in 1.74%, resulting in a 2.91% total perinatal death rate. There was no maternal death. Conclusion. Pregnant women with a previous cesarean delivery should attempt vaginal birth, however, with a liberal obstetrician’s attitude for eventual cesarean delivery.

Keywords

cesarean delivery; delivery after cesarean section; uterine rupture; perinatal mortality

Hrčak ID:

15592

URI

https://hrcak.srce.hr/15592

Publication date:

1.9.2004.

Article data in other languages: croatian

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