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Créée le : 01 Feb 2006
Modifiée le : 01 Dec 2007

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Notice bibliographique (sans auteurs) :

Vaginal Delivery after Cesarean Section -- Is the Risk Acceptable?. NEJM, 345, p.54

Auteur·e(s) :

Greene

Année de publication :

2001

URL(s) :

Résumé (français)  :

Abstract (English)  :

Editorial: The 91 women in the study by Lydon-Rochelle et al. who had uterine ruptures had substantially greater rates of several postpartum complications, suggesting that these ruptures were clinically important and not merely instances of asymptomatic dehiscence. Notably, the incidence of infant death was 10 times as high among the 91 women who had uterine rupture as among the 20,004 who did not (5.5 percent vs. 0.5 percent). It is important to emphasize that this study, like all others to date, was an observational study of the results of clinical practice and not a randomized trial. The relative risk of 3.3 in the present study for uterine rupture in women with a spontaneous onset of labor, as compared with those who underwent elective repeated cesarean section, is consistent with the odds ratio of 2.1 for a similar comparison reported in a recent meta-analysis of 11 studies involving a total of 39,000 subjects. This meta-analysis also found significant increases in the risks of fetal death (odds ratio, 1.7) and of an Apgar score of less than 7 at five minutes (odds ratio, 2.2) associated with a trial of labor as compared with elective repeated cesarean delivery. These risk estimates reflect broad experience in a wide range of clinical-practice settings. There is no reason to believe that improvements in clinical care can substantially reduce the risks of uterine rupture and perinatal mortality. Given the potential risks, why might a woman choose a trial of labor? Women who successfully deliver vaginally generally have less postpartum discomfort, shorter hospital stays, and shorter periods of disability than women who undergo repeated cesarean section. A trial of labor may be associated with a lower risk of fever than elective repeated cesarean section. Women who plan future pregnancies may prefer to avoid repeated cesarean deliveries that further increase the risks of uterine rupture, placenta accreta, and morbidity related to multiple abdominal surgeries. Finally, there may be social and cultural reasons why some women prefer vaginal delivery. … After a thorough discussion of the risks and benefits of attempting a vaginal delivery after cesarean section, a patient might ask, "But doctor, what is the safest thing for my baby?" Given the findings of Lydon-Rochelle et al., my unequivocal answer is: elective repeat cesarean section.

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Resumen (español)  :

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Fiche importée de http://www.worldserver.com/turk/birthing/rrvbac2000-4.html avec l’aide de Ken Turkowski, septembre 2005

Argument (français) :

Argument (English):

Argumento (português):

Argumento (español):

Mots-clés :

➡ accouchement vaginal après césarienne ; césarienne

Auteur·e de cette fiche :

Ken Turkowski — 01 Feb 2006