Elective repeat cesarean delivery compared with spontaneous trial of labor after a prior cesarean delivery: a propensity score analysis - 30/03/12

Doi : 10.1016/j.ajog.2012.02.002

Sharon A. Gilbert, MS, MBA ^a, William A. Grobman, MD, MBA ^b, Mark B. Landon, MD ^c, Catherine Y. Spong, MD ^p, Dwight J. Rouse, MD ^d, Kenneth J. Leveno, MD ^e, Michael W. Varner, MD ^f, Steve N. Caritis, MD ^g, Paul J. Meis, MD ^h, Yoram Sorokin, MD ⁱ, Marshall Carpenter, MD ^j, Mary J. O'Sullivan, MD ^k, Baha M. Sibai, MD ^l, John M. Thorp, MD ^m, Susan M. Ramin, MD ⁿ, Brian M. Mercer, MD ^o
Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network
^a The George Washington University Biostatistics Center, Washington, DC
^b Departments of Obstetrics and Gynecology at Northwestern University, Chicago, IL
^c The Ohio State University, Columbus, OH
^d University of Alabama at Birmingham, Birmingham, AL
^e University of Texas Southwestern Medical Center, Dallas, TX
^f University of Utah, Salt Lake City, UT
^g University of Pittsburgh, Pittsburgh, PA
^h Wake Forest University Health Sciences, Winston-Salem, NC
ⁱ Wayne State University, Detroit, MI
^j Brown University, Providence, RI
^k University of Miami, Miami, FL
^l University of Tennessee, Memphis, TN
^m University of North Carolina at Chapel Hill, Chapel Hill, NC
ⁿ The University of Texas Health Science Center at Houston, Houston, TX
^o Case Western Reserve University-MetroHealth Medical Center, Cleveland, OH
^p Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD

Résumé

Objective

The purpose of this study was to determine outcomes, after the use of propensity score techniques, to create balanced groups according to whether a woman undergoes elective repeat cesarean delivery (ERCD) or trial of labor (TOL).

Study Design

Women who were eligible for a TOL with 1 previous low transverse incision were categorized according to whether they underwent an ERCD or TOL. A propensity score technique was used to develop ERCD and TOL groups with comparable baseline characteristics. Outcomes were assessed with conditional logistic regression.

Results

The rates of endometritis, operative injury, respiratory distress syndrome, and newborn infant infection were lower and the rates of hysterectomy and wound complication were higher in the ERCD group.

Conclusion

Propensity score techniques can be used to generate comparable ERCD and TOL groups. Some types of maternal morbidity (such as hysterectomy) are higher; other types (such as operative injury) are lower in the ERCD group. Although the absolute risk is low, neonatal morbidity appears to be lower in the ERCD group.

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Key words : elective repeat cesarean delivery, propensity score, trial of labor

Plan

Materials and Methods

Results

Comment

	Other members of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network are listed in the Acknowledgments section of this article.
	Supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health (HD21410, HD21414, HD27860, HD27861, HD27869, HD27905, HD27915, HD27917, HD34116, HD34122, HD34136, HD34208, HD34210, HD40500, HD40485, HD40544, HD40545, HD40560, HD40512, and HD36801) and its contents are solely the responsibility of the authors and do not necessarily represent the official view of National Institute of Child Health and Human Development or the National Institutes of Health.
	The authors report no conflict of interest.
	The racing flag logo above indicates that this article was rushed to press for the benefit of the scientific community.
	Cite this article as: Gilbert SA, Grobman WA, Landon MB, et al. Elective repeat cesarean delivery compared with spontaneous trial of labor after a prior cesarean delivery: a propensity score analysis. Am J Obstet Gynecol 2012;206:311.e1-9.
	Reprints not available from the authors.

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Vol 206 - N° 4

P. 311.e1-311.e9 - avril 2012 Retour au numéro

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Elective repeat cesarean delivery compared with spontaneous trial of labor after a prior cesarean delivery: a propensity score analysis - 30/03/12

Résumé

Objective

Study Design

Results

Conclusion

Plan

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