By Karen Troy
Co-Leader, ICAN of Chicago
Welcome to the first monthly installment of our new blog feature – VBAC Literature Update. Each month I will provide a list of new peer reviewed literature that has been published with the past 30 days on the topic of VBAC. I will also provide some commentary on what I believe is important/relevant about each article. The abstracts to each of these articles, and often the full text, can be accessed at www.pubmed.gov, the National Library of Medicine.
1: Khaskheli M, Baloch S, Baloch AS. Obstetrical trauma to the genital tract
following vaginal delivery. J Coll Physicians Surg Pak. 2012 Feb;22(2):95-7.
PubMed PMID: 22313645.
This article is from a third-tier Pakastani journal, and the findings are not relevant to how medicine is practiced in the United States or other industrialized countries. For instance, they report a 37% rupture rate in grand multiparas (women with more than 5 children) and a 16% maternal mortality rate. We can all be thankful that our outcomes are significantly better than this!
2: Teguete I, Maiga AW, Leppert PC. Maternal and neonatal outcomes of grand
multiparas over two decades in Mali. Acta Obstet Gynecol Scand. 2012 Feb 7. doi:
10.1111/j.1600-0412.2012.01372.x. [Epub ahead of print] PubMed PMID: 22313177.
Another study similar to the first, but in Mali. They found that women with many children tend to have fewer birth complications than women with fewer children, probably because if you weren’t healthy to begin with you wouldn’t be on your 5th, 6th or 7th child!
3: Nooh A. Is it worth inducing labour in women with a previous caesarean
delivery? J Obstet Gynaecol. 2012 Feb;32(2):141-4. PubMed PMID: 22296423.
This is a case series that examines outcomes in women who were planning VBACs and were induced. The study design is not particularly strong. The journal is not particularly strong, probably because this is the only place this author could get the research published. I would not put a lot of weight into the data reported here, but do agree with the author that inductions should involve a shared decision making process between moms and doctors, carefully weighing the pros and cons, especially in a VBAC situation.
4: Benson MD, Cheema N, Kaufman MW, Goldschmidt RA, Beaumont JL. Uterine
Intravascular Fetal Material and Coagulopathy at Peripartum Hysterectomy. Gynecol
Obstet Invest. 2012 Jan 19. [Epub ahead of print] PubMed PMID: 22261240.
This one got pulled because it mentions uterine rupture as a factor in the problem they’re exploring, but it doesn’t have anything to do with VBAC.
5: Barros FC, Matijasevich A, Hallal PC, Horta BL, Barros AJ, Menezes AB, Santos
IS, Gigante DP, Victora CG. Cesarean section and risk of obesity in childhood,
adolescence, and early adulthood: evidence from 3 Brazilian birth cohorts. Am J
Clin Nutr. 2012 Feb;95(2):465-70. Epub 2012 Jan 11. PubMed PMID: 22237058; PubMed
Central PMCID: PMC3260073.
These authors wanted to know whether cesarean birth was associated with long-term obesity rates. The theory is that because babies born via c-section don’t get inoculated with all of those lovely bacteria on their way out, their guts are not populated in the same way as vaginal birthed babies. This may influence how people digest food and absorb calories. Turns out there is not an association with cesarean birth and obesity. I’m not sure why this came up in my VBAC search.
6: Sun HD, Su WH, Chang WH, Wen L, Huang BS, Wang PH. Rupture of a pregnant
unscarred uterus in an early secondary trimester: A case report and brief review.
J Obstet Gynaecol Res. 2012 Feb;38(2):442-445. doi:
10.1111/j.1447-0756.2011.01723.x. Epub 2012 Jan 10. PubMed PMID: 22229814.
Case report of an unfortunate woman who spontaneously ruptured during pregnancy. Not relevant to VBAC.
7: Tinelli A, Hurst BS, Hudelist G, Tsin DA, Stark M, Mettler L, Guido M, Malvasi
A. Laparoscopic myomectomy focusing on the myoma pseudocapsule: technical and
outcome reports. Hum Reprod. 2012 Feb;27(2):427-35. Epub 2011 Nov 16. PubMed
This is a series of women who had laparoscopic myomectomy (this is minimally invasive surgery to remove uterine fibroids) and then subsequently got pregnant and gave birth. In this group most of the women did get pregnant after fibroid surgery and most of them had vaginal births. 32% had cesareans. When you consider that the national average is 32%, this isn’t too bad. They do not report any ruptures after myomectomy. For more information on myomectomy and birth options, please see the special scar website here: www.specialscars.org
8: Jackson S, Fleege L, Fridman M, Gregory K, Zelop C, Olsen J. Morbidity
following primary cesarean delivery in the Danish National Birth Cohort. Am J
Obstet Gynecol. 2012 Feb;206(2):139.e1-5. Epub 2011 Sep 24. PubMed PMID:
This is a retrospective study comparing second pregnancies in a group of 21,500 women who had a vaginal first birth to 3340 women who had cesarean first births (all in Denmark). Not surprisingly, mothers with prior cesareans had a higher risk of complications with subsequent births. Nothing particularly new here, though this does add to the data set on this sort of thing.
10: Brailovschi Y, Sheiner E, Wiznitzer A, Shahaf P, Levy A. Risk factors for
intrapartum fetal death and trends over the years. Arch Gynecol Obstet. 2012
Feb;285(2):323-9. Epub 2011 Jul 7. PubMed PMID: 21735187.
This examines risk factors for intrapartum fetal death and concludes that uterine rupture, among other factors, is a risk. Duh.
11: Ronel D, Wiznitzer A, Sergienko R, Zlotnik A, Sheiner E. Trends, risk factors
and pregnancy outcome in women with uterine rupture. Arch Gynecol Obstet. 2012
Feb;285(2):317-21. Epub 2011 Jul 7. PubMed PMID: 21735183.
This study examined a cohort of 240,189 singleton births occurring between 1988 and 2009. Of these, rupture occurred in 138 births (0.06%) total, increasing from 0.01% in 1988 to 0.05% in 2009. Their statistics are presented in a confusing way, but in a nutshell, previous cesarean delivery increases your odds of uterine rupture, not surprisingly. I was hoping to see something in here that was actually modifiable by either mom or doctor as being significantly different between the rupture and non-rupture group, but this was not the case. All in all, disappointing as an article.