15 / 108
B
irth
route
in
case
of
cesarean
section
in
a
previous
pregnancy
R
ev
A
ssoc
M
ed
B
ras
2015; 61(3):196-202
199
As a secondary outcome, maternal morbidity and
mortality were assessed, including maternal death,
uterine rupture, severe bleeding, need for blood
transfusion, need for uterine curettage due to pres-
ence of ovular debris, hysterectomy, need for sur-
gical treatment of vulvar or perineal hematoma,
pulmonary embolism, thromboembolic events,
pneumonia, surgical wound infection, dehiscence,
bowel, bladder or ureter injury requiring surgical
treatment, genital tract
fistulae
.
•
•
Results: of the 2,345 pregnant women, 1,108 un-
derwent cesarean elective delivery (including 10
randomized to such procedure), while 1,237 un-
derwent planned vaginal delivery (with 12 cases
being randomized to this type of delivery). In this
study, the authors found that among women un-
dergoing cesarean delivery, outcomes related to
perinatal and neonatal morbidity and mortality
were significantly less frequent compared to wom-
en undergoing planned vaginal delivery (0.9
versus
2.4%, respectively). With respect to secondary out-
comes relating to maternal morbidity and mortal-
ity, there was no significant difference between
groups (RR=0.69 with 95%CI: 0.46 to 1.05). It is
worth noting that the data reported here refer to
a cohort study and, given the small sample of pa-
tients randomized, risks cannot be estimated.
2. Landon MB, et al. (
B
)
.
7
•
•
Design: multicenter, prospective, observational
longitudinal study (1999 to 2002).
•
•
Population: out of 45,988 women presenting sin-
gleton pregnancies and history of previous cesare-
an delivery, n=17,898 underwent trial of labor and
15,801 underwent elective cesarean section. We must
underscore that heterogeneity between these two
groups existed mainly regarding maternal age, eth-
nicity, smoking status, body mass index, history of
vaginal delivery, number of previous cesarean sec-
tions, the presence of maternal or obstetric disease,
weight and gestational age at birth.
•
•
Outcome: to assess maternal, perinatal and neo-
natal morbidity and mortality.
•
•
Results: over the four years, higher maternal mor-
tality was observed, with regard to the need for
blood transfusion and occurrence of endometrio-
sis among women undergoing trial of labor to the
detriment of elective cesarean section (RR=0.589
with 95%CI: 0.484 to 0.716, and RR=0.624 with
95%CI: 0.540 to 0.722, respectively). Analyzing cas-
es of uterine rupture, the authors found that 124
cases were reported among women undergoing tri-
al of labor
versus
the absence of this outcome for
births that occurred by means of cesarean section.
Regarding the occurrence of maternal death and
need for hysterectomy, there was no difference be-
tween groups.
In neonatal morbidity and mortality analysis,
the authors observed that hypoxic-ischemic en-
cephalopathy occurrences were among the babies
born vaginally (12 cases)
versus
the absence of this
outcome for elective cesarean section.
3. Eriksen NL, et al. (
B
)
.
8
•
•
Design: non-concurrent observational longitudi-
nal study.
•
•
Population: records of 152 pregnant women with
a previous cesarean section were reviewed. 68 wom-
en underwent elective cesarean section, while 73
underwent planned vaginal delivery.
•
•
Outcome: maternal, perinatal and neonatal mor-
bidity and mortality.
•
•
Results: regarding maternal and neonatal morbid-
ity and mortality, there were no differences be-
tween the two types of delivery.
4. FlammBL, et al. (
B
)
.
9
•
•
Design: prospective observational longitudinal
study.
•
•
Population: of the 7,229 women with a previous
cesarean section, 5,022 underwent trial of labor,
and 2,207 underwent elective cesarean section.
•
•
Outcome: maternal morbidity and mortality.
•
•
Results: the need for blood transfusion and the in-
cidence of febrile complications during the post-
partum period were significantly higher among
women undergoing elective cesarean section.
5. Loebel G, et al. (
B
)
.
10
•
•
Design: non-concurrent observational longitudi-
nal study.
•
•
Population: records of 1,408 pregnant women
(pregnant women with singleton pregnancy at term
and a previous cesarean section) were reviewed.
•
•
Outcome: maternal, perinatal and neonatal mor-
bidity and mortality.
•
•
Results: regarding maternal morbidity and mor-
tality, there was no significant difference in the
need for blood transfusion, infection, uterine rup-
ture and surgical lesion between the two birth