Source: Obstet Gynecol 2007;110:814-819
By Will Boggs, MD
NEW YORK (Reuters Health) Oct 19 - Women who have had a prior cesarean
delivery for a multiple gestation can usually undergo a successful trial of
labor in a subsequent singleton pregnancy, according to a report in the
October issue of Obstetrics & Gynecology.
"Given the progressive increase in multiple gestation rates and the
increasing frequency with which multiple gestations are delivered by
cesarean, it is likely that this clinical situation will be encountered more
frequently in coming years," Dr. Michael W. Varner told Reuters Health.
Dr. Varner from the University of Utah, Salt Lake City, and colleagues
analyzed outcomes of singleton pregnancies among 944 women with one previous
cesarean delivery for multifetal gestation compared with 28,329 women who'd
had one previous cesarean delivery for a singleton pregnancy.
A trial of labor was attempted by 59% of the women whose prior cesarean
delivery was for a multiple pregnancy and by 47.5% of those whose previous
cesarean delivery was for a singleton pregnancy. The vaginal delivery rates
in the two groups were 85.6% and 73.1%, respectively, the authors report.
Women with a prior cesarean delivery for multiple pregnancy who chose a
trial of labor were more likely to have had a prior vaginal delivery and
were of higher parity but lower body mass index at delivery than were
similar women who chose to have an elective cesarean delivery.
Compared to women who had an unsuccessful trial of labor, women who had a
successful trial of labor had higher parity and were more likely to have had
a previous vaginal delivery and a previous intervening successful trial of
labor, the investigators say.
Gestational age at delivery, birth weight, perinatal death rates, and low
5-minute Apgar scores did not differ between women whose prior cesarean
delivery was for multiple pregnancy and women whose previous cesarean
delivery was for a singleton pregnancy, the report indicates.
Newborns of mothers attempting a trial of labor after a prior cesarean
delivery for multiple pregnancy were less likely than newborns of mothers
attempting a trial of labor after a prior cesarean delivery of a singleton
pregnancy to require neonatal intensive care unit admission, the researchers
note.
"These data suggest that a trial of labor remains a reasonable consideration
for women pregnant with a singleton vertex pregnancy whose one previous
cesarean delivery was for a multifetal pregnancy," the authors conclude.
Obstet Gynecol 2007;110:814-819.
