Maternal and Neonatal Outcomes of Repeat Cesarean Delivery in Women with a Prior Classical versus Low Transverse Uterine Incision

Tiki Bakhshi; Mark B Landon; Yinglei Lai; Catherine Y Spong; Dwight J Rouse; Kenneth J Leveno; Michael W Varner; Steve N Caritis; Paul J Meis; Ronald J Wapner; Yoram Sorokin; Menachem Miodovnik; Marshall Carpenter; Alan M Peaceman; Mary J O'Sullivan; Baha M Sibai; Oded Langer; John M Thorp; Brian M Mercer

doi:10.1055/s-0030-1254238

American Journal of Perinatology, Table of Contents

Am J Perinatol 2010; 27(10): 791-796
DOI: 10.1055/s-0030-1254238

Maternal and Neonatal Outcomes of Repeat Cesarean Delivery in Women with a Prior Classical versus Low Transverse Uterine Incision

Tiki Bakhshi¹ , Mark B. Landon² , Yinglei Lai¹⁹ , Catherine Y. Spong²⁰ , Dwight J. Rouse³ , Kenneth J. Leveno⁴ , Michael W. Varner⁵ , Steve N. Caritis⁶ , Paul J. Meis⁷ , Ronald J. Wapner⁸ , Yoram Sorokin⁹ , Menachem Miodovnik¹⁰ ^, ¹¹ , Marshall Carpenter¹² , Alan M. Peaceman¹³ , Mary J. O'Sullivan¹⁴ , Baha M. Sibai¹⁵ , Oded Langer¹⁶ , John M. Thorp¹⁷ , Brian M. Mercer¹⁸

¹Departments of Obstetrics and Gynecology, The University of Texas Health Science Center at Houston, Houston, Texas
²The Ohio State University, Columbus, Ohio
³University of Alabama at Birmingham, Birmingham, Alabama
⁴University of Texas Southwestern Medical Center, Dallas, Texas
⁵University of Utah, Salt Lake City, Utah
⁶University of Pittsburgh, Pittsburgh, Pennsylvania
⁷Wake Forest University Health Sciences, Winston-Salem, North Carolina
⁸Thomas Jefferson University, Philadelphia, Pennsylvania
⁹Wayne State University, Detroit, Michigan
¹⁰University of Cincinnati, Cincinnati, Ohio
¹¹Columbia University, New York, New York
¹²Brown University, Providence, Rhode Island
¹³Northwestern University, Chicago, Illinois
¹⁴University of Miami, Miami, Florida
¹⁵University of Tennessee, Memphis, Tennessee
¹⁶University of Texas Health Science Center at San Antonio, San Antonio, Texas
¹⁷University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
¹⁸Case Western Reserve University, Cleveland, Ohio
¹⁹The George Washington University Biostatistics Center, Washington, DC
²⁰Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network, Bethesda, Maryland

Abstract

ABSTRACT

We compared maternal and neonatal outcomes following repeat cesarean delivery (CD) of women with a prior classical CD with those with a prior low transverse CD. The Maternal Fetal Medicine Units Network Cesarean Delivery Registry was used to identify women with one previous CD who underwent an elective repeat CD prior to the onset of labor at ≥36 weeks. Outcomes were compared between women with a previous classical CD and those with a prior low transverse CD. Of the 7936 women who met study criteria, 122 had a prior classical CD. Women with a prior classical CD had a higher rate of classical uterine incision at repeat CD (12.73% versus 0.59%; p < 0.001), had longer total operative time and hospital stay, and had higher intensive care unit admission. Uterine dehiscence was more frequent in women with a prior classical CD (2.46% versus 0.27%, odds ratio 9.35, 95% confidence interval 1.76 to 31.93). After adjusting for confounding factors, there were no statistical differences in major maternal or neonatal morbidities between groups. Uterine dehiscence was present at repeat CD in 2.46% of women with a prior classical CD. However, major maternal morbidities were similar to those with a prior low transverse CD.

KEYWORDS

Cesarean delivery - classical cesarean delivery - prior cesarean - maternal outcomes - neonatal outcomes

Full Text

References

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Tiki BakhshiM.D.

Department of OB/GYN, Tripler Army Medical Center

1 Jarrett White Road, Honolulu, HI 96859-5000

Email: tiki.bakhshi@amedd.army.mil