Maternal and perinatal outcomes of women with vaginal birth after cesarean section compared to repeat cesarean birth in select South Asian and Latin American settings of the global network for women's and children's health research

• Published in: Maternal health, neonatology and perinatology Vol. 9; no. 1; pp. 13 - 9
• Main Authors: Figueroa, Lester, Harrison, Margo, Mazariegos, Manolo, Goudar, Shivaprasad, Kavi, Avinash, Derman, Richard, Patel, Archana, Das, Prabir, Hibberd, Patricia L, Saleem, Sarah, Naqvi, Farnaz, Goldenberg, Robert L, Haque, Rashidul, Billah, Sk Masum, Petri, Jr, William A, McClure, Elizabeth M, Tan, Sylvia, Krebs, Nancy F
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 01-11-2023; BioMed Central; BMC
• Subjects: Antibiotics; Birth rate; Births; Body mass index; Breast feeding; Breastfeeding & lactation; Cesarean birth; Cesarean section; Childbirth & labor; Children; Childrens health; Comparative analysis; Facility-based delivery; Health aspects; Hypertension; Low income areas; Low- and middle-income countries; Maternal outcomes; Medical research; Mode of birth; Obstetrics; Population studies; Pregnancy; Premature birth; Prenatal care; Repeat cesarean birth; Stillbirth; Vagina; Women; Womens health; Guatemala; Bangladesh; Pakistan; Africa; Repeat cesarean birth; Breastfeeding initiation; Low- and middle-income countries; Facility-based delivery; Neonatal outcomes; Cesarean birth; Maternal outcomes; Vaginal birth after cesarean; Mode of birth
• ISSN: 2054-958X; 2054-958X
• DOI: 10.1186/s40748-023-00169-x

Our objective was to analyze a prospective population-based registry including five sites in four low- and middle-income countries to observe characteristics associated with vaginal birth after cesarean versus repeat cesarean birth, as well as maternal and newborn outcomes associated with the mode of birth among women with a history of prior cesarean.
Maternal and perinatal outcomes among vaginal birth after cesarean section will be similar to those among recurrent cesarean birth.
A prospective population-based study, including home and facility births among women enrolled from 2017 to 2020, was performed in communities in Guatemala, India (Belagavi and Nagpur), Pakistan, and Bangladesh. Women were enrolled during pregnancy, and delivery outcome data were collected within 42 days after birth.
We analyzed 8267 women with a history of prior cesarean birth; 1389 (16.8%) experienced vaginal birth after cesarean, and 6878 (83.2%) delivered by a repeat cesarean birth. Having a repeat cesarean birth was negatively associated with a need for curettage (ARR 0.12 [0.06, 0.25]) but was positively associated with having a blood transfusion (ARR 3.74 [2.48, 5.63]). Having a repeat cesarean birth was negatively associated with stillbirth (ARR 0.24 [0.15, 0.49]) and, breast-feeding within an hour of birth (ARR 0.39 [0.30, 0.50]), but positively associated with use of antibiotics (ARR 1.51 [1.20, 1.91]).
In select South Asian and Latin American low- and middle-income sites, women with a history of prior cesarean birth were 5 times more likely to deliver by cesarean birth in the hospital setting. Those who delivered vaginally had less complicated pregnancy and labor courses compared to those who delivered by repeat cesarean birth, but they had an increased risk of stillbirth. More large scale studies are needed in Low Income Country settings to give stronger recommendations.
NCT01073475, Registered February 21, 2010, https://clinicaltrials.gov/ct2/show/record/NCT01073475 .