Evaluating Facility-Based Decision-Making in Women with a Prior Cesarean Delivery and Association with Maternal and Peri
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Evaluating Facility-Based Decision-Making in Women with a Prior Cesarean Delivery and Association with Maternal and Perinatal Outcomes Adeline Adwoa Boatin1 · Kwame Adu‑Bonsaffoh2 · Blair Johnson Wylie3 · Samuel A. Obed4
© Springer Science+Business Media, LLC 2017
Abstract Objective To describe facility-based decisionmaking for women with one prior cesarean delivery (CD) in a resource-limited setting and to characterize maternal and perinatal outcomes in these groups. Methods One year retrospective study of women with one prior CD delivering at Korle-Bu Teaching Hospital (KBTH), Ghana. Women were categorized into three groups based on initial plan of management on admission [trial of labor after cesarean (TOLAC), emergency repeat CD (EMCD) or non-emergent repeat CD (RCD)]. Characteristics and outcomes across these groups were then compared. Results During the study period, 1247 women with one prior CD delivered at KBTH, of which 377 (30.2%) were triaged to RCD, 439 (35.2%) to EMCD and 431 (34.6%) to TOLAC. Twelve uterine ruptures and no maternal deaths occurred. Perinatal mortality was 4.2% (n = 52). Compared to the RCD group, the TOLAC group had a lower risk for maternal adverse events (aOR 0.3, 95% CI 0.1–1.0; p = 0.04) and non-significant Electronic supplementary material The online version of this article (doi:10.1007/s10995-017-2302-3) contains supplementary material, which is available to authorized users. * Adeline Adwoa Boatin [email protected] 1
Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Founders 5, Boston, MA 02114, USA
2
Department of Obstetrics and Gynecology, Korle-Bu Teaching Hospital, Accra, Ghana
3
Division of Maternal‑Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
4
Department of Obstetrics and Gynecology, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
higher risk of perinatal adverse events (aOR 1.6, 95% CI 0.7–3.3; p = 0.25). Compared to women triaged to RCD, the EMCD group had a non-significant increase in risk of maternal adverse events (aOR 1.6, 95% CI 0.8–3.5; p = 0.2) and a significantly higher rate of perinatal adverse events (aOR 2.4, 95% CI 1.2–4.9; p = 0.01). Conclusions for Practice Women triaged to EMCD at admission are different when compared to women allowed a TOLAC or offered a non-emergent RCD. These women bear increased rates of adverse outcomes and should be considered as a separate group for analysis in future studies conducted in similar settings. Keywords Trial of labor after cesarean · Vaginal birth after cesarean · Antenatal care · Intrapartum decisionmaking · Emergency repeat cesarean delivery · Repeat cesarean delivery
Significance Statement What is already known on this subject? Clinicians managing women with a prior cesarean delivery undergoing facility-based management in resource-limited settings in Sub-Saharan Africa face three tr
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