Adverse Obstetric Outcomes in Women with Previous Cesarean for Dystocia in Second Stage of Labor

Nicole Jastrow; Suzanne Demers; Robert J. Gauthier; Nils Chaillet; Normand Brassard; Emmanuel Bujold

doi:10.1055/s-0032-1322515

American Journal of Perinatology, Inhaltsverzeichnis

Am J Perinatol 2013; 30(03): 173-178
DOI: 10.1055/s-0032-1322515

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Adverse Obstetric Outcomes in Women with Previous Cesarean for Dystocia in Second Stage of Labor

Authors

Nicole Jastrow

¹Department of Obstetrics and Gynaecology, Faculty of Medicine, Hôpitaux Universitaires de Genève, Université de Genève, Genève, Suisse
Suzanne Demers

²Department of Obstetrics and Gynaecology, Centre hospitalier universitaire de Québec (CHUQ), Université Laval, Québec, Canada
Robert J. Gauthier

³Department of Obstetrics and Gynaecology, Hôpital Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
Nils Chaillet

³Department of Obstetrics and Gynaecology, Hôpital Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
Normand Brassard

²Department of Obstetrics and Gynaecology, Centre hospitalier universitaire de Québec (CHUQ), Université Laval, Québec, Canada
Emmanuel Bujold

²Department of Obstetrics and Gynaecology, Centre hospitalier universitaire de Québec (CHUQ), Université Laval, Québec, Canada

Abstract

Objective To evaluate obstetric outcomes in women undergoing a trial of labor (TOL) after a previous cesarean for dystocia in second stage of labor.

Methods A retrospective cohort study of women with one previous low transverse cesarean undergoing a first TOL was performed. Women with previous cesarean for dystocia in first stage and those with previous dystocia in second stage were compared with those with previous cesarean for nonrecurrent reasons (controls). Multivariable regressions analyses were performed.

Results Of 1655 women, those with previous dystocia in second stage of labor (n = 204) had greater risks than controls (n = 880) to have an operative delivery [odds ratio (OR): 1.5; 95% confidence intervals (CI) 1.1 to 2.2], shoulder dystocia (OR: 2.9; 95% CI 1.1 to 8.0), and uterine rupture in the second stage of labor (OR: 4.9; 95% CI 1.1 to 23), and especially in case of fetal macrosomia (OR: 29.6; 95% CI 4.4 to 202). The median second stage of labor duration before uterine rupture was 2.5 hours (interquartile range: 1.5 to 3.2 hours) in these women.

Conclusion Previous cesarean for dystocia in the second stage of labor is associated with second-stage uterine rupture at next delivery, especially in cases of suspected fetal macrosomia and prolonged second stage of labor.

Keywords

pregnancy - vaginal birth after cesarean - uterine rupture - labor dystocia

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