Elective repeat cesarean delivery compared with spontaneous trial of labor after a prior cesarean delivery: A propensity score analysis

Sharon A. Gilbert, William A. Grobman, Mark B. Landon, Catherine Y. Spong, Dwight J. Rouse, Kenneth J. Leveno, Michael W. Varner, Steve N. Caritis, Paul J. Meis, Yoram Sorokin, Marshall Carpenter, Mary J. O'Sullivan, Baha M. Sibai, John M. Thorp, Susan M. Ramin, Brian M. Mercer

Research output: Contribution to journalArticle

28 Scopus citations

Abstract

OBJECTIVE: The purpose of this study was to determine outcomes, after the use of propensity score techniques, to create balanced groups according to whether a woman undergoes elective repeat cesarean delivery (ERCD) or trial of labor (TOL). STUDY DESIGN: Women who were eligible for a TOL with 1 previous low transverse incision were categorized according to whether they underwent an ERCD or TOL. A propensity score technique was used to develop ERCD and TOL groups with comparable baseline characteristics. Outcomes were assessed with conditional logistic regression. The rates of endometritis, operative injury, respiratory distress syndrome, and newborn infant infection were lower and the rates of hysterectomy and wound complication were higher in the ERCD group. CONCLUSION: Propensity score techniques can be used to generate comparable ERCD and TOL groups. Some types of maternal morbidity (such as hysterectomy) are higher; other types (such as operative injury) are lower in the ERCD group. Although the absolute risk is low, neonatal morbidity appears to be lower in the ERCD group.

Original languageEnglish (US)
Pages (from-to)311.e1-311.e9
JournalAmerican journal of obstetrics and gynecology
Volume206
Issue number4
DOIs
StatePublished - Apr 2012

Keywords

  • elective repeat cesarean delivery
  • propensity score
  • trial of labor

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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    Gilbert, S. A., Grobman, W. A., Landon, M. B., Spong, C. Y., Rouse, D. J., Leveno, K. J., Varner, M. W., Caritis, S. N., Meis, P. J., Sorokin, Y., Carpenter, M., O'Sullivan, M. J., Sibai, B. M., Thorp, J. M., Ramin, S. M., & Mercer, B. M. (2012). Elective repeat cesarean delivery compared with spontaneous trial of labor after a prior cesarean delivery: A propensity score analysis. American journal of obstetrics and gynecology, 206(4), 311.e1-311.e9. https://doi.org/10.1016/j.ajog.2012.02.002