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Evaluating Facility-Based Decision-Making in Women with a Prior Cesarean Delivery and Association with Maternal and Perinatal Outcomes.
Boatin, Adeline Adwoa; Adu-Bonsaffoh, Kwame; Wylie, Blair Johnson; Obed, Samuel A.
Afiliación
  • Boatin AA; Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Founders 5, Boston, MA, 02114, USA. adeline_boatin@mgh.harvard.edu.
  • Adu-Bonsaffoh K; Department of Obstetrics and Gynecology, Korle-Bu Teaching Hospital, Accra, Ghana.
  • Wylie BJ; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
  • Obed SA; Department of Obstetrics and Gynecology, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana.
Matern Child Health J ; 21(9): 1845-1852, 2017 Sep.
Article en En | MEDLINE | ID: mdl-28699093
Objective To describe facility-based decision-making 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 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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Esfuerzo de Parto / Parto Vaginal Después de Cesárea / Cesárea Repetida / Toma de Decisiones Tipo de estudio: Evaluation_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adolescent / Adult / Female / Humans / Pregnancy País/Región como asunto: Africa Idioma: En Revista: Matern Child Health J Asunto de la revista: PERINATOLOGIA Año: 2017 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Esfuerzo de Parto / Parto Vaginal Después de Cesárea / Cesárea Repetida / Toma de Decisiones Tipo de estudio: Evaluation_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adolescent / Adult / Female / Humans / Pregnancy País/Región como asunto: Africa Idioma: En Revista: Matern Child Health J Asunto de la revista: PERINATOLOGIA Año: 2017 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos