Variations over time in mode of birth and perinatal outcomes in women with one previous cesarean in the Netherlands: A 20-year population-based study

IF 2.8 3区医学 Q1 NURSING

Birth-Issues in Perinatal Care Pub Date : 2023-12-01 DOI:10.1111/birt.12803

Ian Koorn MD, MSC, Linda C. Vis MSC, Kim J. C. Verschueren MD, PhD, Ageeth N. Rosman PhD, Thomas van den Akker MD, PhD

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引用次数: 0

Abstract

Background

Globally, cesarean birth rates are rising, and while it can be a lifesaving procedure, cesarean birth is also associated with increased maternal and perinatal risks. This study aims to describe changes over time about the mode of birth and perinatal outcomes in second-pregnancy women with one previous cesarean birth in the Netherlands over the past 20 years.

Methods

We conducted a nationwide, population-based study using the Dutch perinatal registry. The mode of birth (intended vaginal birth after cesarean (VBAC) compared with planned cesarean birth) was assessed in all women with one previous cesarean birth and no prior vaginal birth who gave birth to a term singleton in cephalic presentation between 2000 and 2019 in the Netherlands (n = 143,146). The reported outcomes include the trend of intended VBAC, VBAC success rate, and adverse perinatal outcomes (perinatal mortality up to 7 days, low Apgar score at 5 min, asphyxia, and neonatal intensive care unit admission ≥24 h).

Results

Intended VBAC decreased by 21.5% in women with one previous cesarean birth and no prior vaginal birth, from 77.2% in 2000 to 55.7% in 2019, with a marked deceleration from 2009 onwards. The VBAC success rate dropped gradually, from 71.0% to 65.3%, across the same time period. Overall, the cesarean birth rate (planned and unplanned) increased from 45.2% to 63.6%. Adverse perinatal outcomes were higher in women intending VBAC compared with those planning a cesarean birth. Perinatal mortality initially decreased but remained stable from 2009 onwards, with only minimal differences between both modes of birth.

Conclusions

In the Netherlands, the proportion of women intending VBAC after one previous cesarean birth and no prior vaginal birth has decreased markedly. Particularly from 2009 onwards, this decrease was not accompanied by a synchronous reduction in perinatal mortality.

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荷兰有过一次剖宫产的妇女的分娩方式和围产期结局随时间的变化:一项基于20年人口的研究。

背景:在全球范围内，剖宫产率正在上升，虽然它可以是一种挽救生命的手术，但剖宫产也与孕产妇和围产期风险增加有关。本研究旨在描述在过去的20年里，荷兰有过一次剖宫产的二次妊娠妇女的分娩方式和围产期结局随时间的变化。方法:我们使用荷兰围产期登记处进行了一项全国性的、基于人群的研究。在荷兰，对2000年至2019年期间头位分娩足月单胎的所有曾剖腹产一次且未阴道分娩的妇女(n = 143,146)的分娩方式(剖宫产后阴道分娩(VBAC)与计划剖宫产相比)进行了评估。报告的结局包括预期VBAC趋势、VBAC成功率和不良围产期结局(围产期死亡率达7天，5分钟时Apgar评分低，窒息，新生儿重症监护病房住院≥24小时)。结果:有一次剖宫产史和无阴道分娩史的女性的预期VBAC下降了21.5%，从2000年的77.2%下降到2019年的55.7%，从2009年开始明显减速。在同一时期内，VBAC成功率逐渐下降，从71.0%降至65.3%。总体而言，剖宫产率(计划内和计划外)从45.2%增加到63.6%。与计划剖宫产的妇女相比，计划VBAC的妇女的不良围产期结局更高。围产期死亡率最初有所下降，但从2009年起保持稳定，两种分娩方式之间的差异很小。结论:在荷兰，有过一次剖宫产而没有阴道分娩的妇女打算VBAC的比例明显下降。特别是从2009年起，这种下降并没有伴随着围产期死亡率的同步下降。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Birth-Issues in Perinatal Care 医学-妇产科学

CiteScore

4.10

自引率

4.00%

发文量

审稿时长

>12 weeks

期刊介绍： Birth: Issues in Perinatal Care is a multidisciplinary, refereed journal devoted to issues and practices in the care of childbearing women, infants, and families. It is written by and for professionals in maternal and neonatal health, nurses, midwives, physicians, public health workers, doulas, social scientists, childbirth educators, lactation counselors, epidemiologists, and other health caregivers and policymakers in perinatal care.