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- Title
How birth outcomes among a cohort of Guatemalan women with a history of prior cesarean vary by mode or birth across different interpregnancy intervals.
- Authors
Harrison, Margo S.; Garces, Ana; Figueroa, Lester; Westcott, Jamie; Hambidge, Michael; Krebs, Nancy F.
- Abstract
Objectives: Our objectives were to analyze how pregnancy outcomes varied by cesarean birth as compared to vaginal birth across varying interpregnancy intervals (IPI) and determine if IPI modified mode of birth. Methods: This secondary analysis used data from a prospective registry of home and hospital births in Chimaltenango, Guatemala from January 2017 through April 2020, through the Global Network for Women's and Children's Health Research. Bivariate comparisons and multivariable logistic regression were used to answer our study question, and the data was analyzed with STATA software v.15.1. Results: Of 26,465 Guatemalan women enrolled in the registry, 2794 (10.6%) had a history of prior cesarean. 560 (20.1%) women delivered by vaginal birth after cesarean with the remaining 2,233 (79.9%) delivered by repeat cesarean. Repeat cesarean reduced the risk of needing a dilation and curettage compared to vaginal birth after cesarean, but this association did not vary by IPI, all p-values > p = 0.05. Repeat cesarean delivery, as compared to vaginal birth after cesarean, significantly reduced the likelihood a woman breastfeeding within one hour of birth (AOR ranged from 0.009 to 0.10), but IPI was not associated with the outcome. Regarding stillbirth, repeat cesarean birth reduced the likelihood of stillbirth as compared to vaginal birth (AOR 0.2), but again IPI was not associated with the outcome. Conclusion: Outcomes by mode of delivery among a Guatemalan cohort of women with a history of prior cesarean birth do not vary by IPI. Plain English Summary: During a qualitative study where providers at one public hospital in Guatemala were interviewed about their beliefs, attitudes, and general practices regarding mode of delivery among women with a history of prior cesarean birth, providers reported that women with a short interval pregnancy (less than 18 or 24 months depending on provider interviewed) were not candidates for trial of labor after cesarean in their facility due to risk of adverse outcomes. We wished to test the hypothesis that adverse pregnancy outcomes are no more likely with an interval of shorter than 18 or 24 months compared to a longer interval, regardless of whether a woman delivers by vaginal or cesarean birth. This analysis suggests that outcomes can be worse for infants with vaginal birth after cesarean as compared to elective repeat cesarean birth, but these outcomes do not vary by interpregnancy interval. Therefore, our hypothesis was correct, and we look forward to disseminating this information to providers in the region in effort to improve evidence-based obstetric care.
- Subjects
CENTRAL America; HOSPITALS; BIRTH intervals; VAGINAL birth after cesarean; DILATATION &; curettage; PREGNANCY outcomes; VAGINA; CHILDBIRTH at home; PERINATAL death; DESCRIPTIVE statistics; CESAREAN section; DELIVERY (Obstetrics); LOGISTIC regression analysis; DATA analysis software; WOMEN'S health; LONGITUDINAL method; SECONDARY analysis
- Publication
Reproductive Health, 2021, Vol 18, Issue 1, p1
- ISSN
1742-4755
- Publication type
Article
- DOI
10.1186/s12978-021-01153-4