Planned vaginal birth or elective repeat caesarean: patient preference restricted cohort with nested randomised trial.

<h4>Background</h4>Uncertainty exists about benefits and harms of a planned vaginal birth after caesarean (VBAC) compared with elective repeat caesarean (ERC). We conducted a prospective restricted cohort study consisting of a patient preference cohort study, and a small nested randomise...

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Autores principales:	Caroline A Crowther, Jodie M Dodd, Janet E Hiller, Ross R Haslam, Jeffrey S Robinson, Birth After Caesarean Study Group
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2012
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/b4ce1e6b9ca14ed4bd4e2af5b39fb1ed
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spelling	oai:doaj.org-article:b4ce1e6b9ca14ed4bd4e2af5b39fb1ed2021-11-18T05:42:20ZPlanned vaginal birth or elective repeat caesarean: patient preference restricted cohort with nested randomised trial.1549-12771549-167610.1371/journal.pmed.1001192https://doaj.org/article/b4ce1e6b9ca14ed4bd4e2af5b39fb1ed2012-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/22427749/?tool=EBIhttps://doaj.org/toc/1549-1277https://doaj.org/toc/1549-1676<h4>Background</h4>Uncertainty exists about benefits and harms of a planned vaginal birth after caesarean (VBAC) compared with elective repeat caesarean (ERC). We conducted a prospective restricted cohort study consisting of a patient preference cohort study, and a small nested randomised trial to compare benefits and risks of a planned ERC with planned VBAC.<h4>Methods and findings</h4>2,345 women with one prior caesarean, eligible for VBAC at term, were recruited from 14 Australian maternity hospitals. Women were assigned by patient preference (n = 2,323) or randomisation (n = 22) to planned VBAC (1,225 patient preference, 12 randomised) or planned ERC (1,098 patient preference, ten randomised). The primary outcome was risk of fetal death or death of liveborn infant before discharge or serious infant outcome. Data were analysed for the 2,345 women (100%) and infants enrolled. The risk of fetal death or liveborn infant death prior to discharge or serious infant outcome was significantly lower for infants born in the planned ERC group compared with infants in the planned VBAC group (0.9% versus 2.4%; relative risk [RR] 0.39; 95% CI 0.19-0.80; number needed to treat to benefit 66; 95% CI 40-200). Fewer women in the planned ERC group compared with women in the planned VBAC had a major haemorrhage (blood loss ≥ 1,500 ml and/or blood transfusion), (0.8% [9/1,108] versus 2.3% [29/1,237]; RR 0.37; 95% CI 0.17-0.80).<h4>Conclusions</h4>Among women with one prior caesarean, planned ERC compared with planned VBAC was associated with a lower risk of fetal and infant death or serious infant outcome. The risk of major maternal haemorrhage was reduced with no increase in maternal or perinatal complications to time of hospital discharge. Women, clinicians, and policy makers can use this information to develop health advice and make decisions about care for women who have had a previous caesarean.<h4>Trial registration</h4>Current Controlled Trials ISRCTN53974531Caroline A CrowtherJodie M DoddJanet E HillerRoss R HaslamJeffrey S RobinsonBirth After Caesarean Study GroupPublic Library of Science (PLoS)articleMedicineRENPLoS Medicine, Vol 9, Iss 3, p e1001192 (2012)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R
spellingShingle	Medicine R Caroline A Crowther Jodie M Dodd Janet E Hiller Ross R Haslam Jeffrey S Robinson Birth After Caesarean Study Group Planned vaginal birth or elective repeat caesarean: patient preference restricted cohort with nested randomised trial.
description	<h4>Background</h4>Uncertainty exists about benefits and harms of a planned vaginal birth after caesarean (VBAC) compared with elective repeat caesarean (ERC). We conducted a prospective restricted cohort study consisting of a patient preference cohort study, and a small nested randomised trial to compare benefits and risks of a planned ERC with planned VBAC.<h4>Methods and findings</h4>2,345 women with one prior caesarean, eligible for VBAC at term, were recruited from 14 Australian maternity hospitals. Women were assigned by patient preference (n = 2,323) or randomisation (n = 22) to planned VBAC (1,225 patient preference, 12 randomised) or planned ERC (1,098 patient preference, ten randomised). The primary outcome was risk of fetal death or death of liveborn infant before discharge or serious infant outcome. Data were analysed for the 2,345 women (100%) and infants enrolled. The risk of fetal death or liveborn infant death prior to discharge or serious infant outcome was significantly lower for infants born in the planned ERC group compared with infants in the planned VBAC group (0.9% versus 2.4%; relative risk [RR] 0.39; 95% CI 0.19-0.80; number needed to treat to benefit 66; 95% CI 40-200). Fewer women in the planned ERC group compared with women in the planned VBAC had a major haemorrhage (blood loss ≥ 1,500 ml and/or blood transfusion), (0.8% [9/1,108] versus 2.3% [29/1,237]; RR 0.37; 95% CI 0.17-0.80).<h4>Conclusions</h4>Among women with one prior caesarean, planned ERC compared with planned VBAC was associated with a lower risk of fetal and infant death or serious infant outcome. The risk of major maternal haemorrhage was reduced with no increase in maternal or perinatal complications to time of hospital discharge. Women, clinicians, and policy makers can use this information to develop health advice and make decisions about care for women who have had a previous caesarean.<h4>Trial registration</h4>Current Controlled Trials ISRCTN53974531
format	article
author	Caroline A Crowther Jodie M Dodd Janet E Hiller Ross R Haslam Jeffrey S Robinson Birth After Caesarean Study Group
author_facet	Caroline A Crowther Jodie M Dodd Janet E Hiller Ross R Haslam Jeffrey S Robinson Birth After Caesarean Study Group
author_sort	Caroline A Crowther
title	Planned vaginal birth or elective repeat caesarean: patient preference restricted cohort with nested randomised trial.
title_short	Planned vaginal birth or elective repeat caesarean: patient preference restricted cohort with nested randomised trial.
title_full	Planned vaginal birth or elective repeat caesarean: patient preference restricted cohort with nested randomised trial.
title_fullStr	Planned vaginal birth or elective repeat caesarean: patient preference restricted cohort with nested randomised trial.
title_full_unstemmed	Planned vaginal birth or elective repeat caesarean: patient preference restricted cohort with nested randomised trial.
title_sort	planned vaginal birth or elective repeat caesarean: patient preference restricted cohort with nested randomised trial.
publisher	Public Library of Science (PLoS)
publishDate	2012
url	https://doaj.org/article/b4ce1e6b9ca14ed4bd4e2af5b39fb1ed
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Planned vaginal birth or elective repeat caesarean: patient preference restricted cohort with nested randomised trial.

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