Mode of Delivery in Women with Antepartum Fetal Death and Prior Cesarean Delivery

We describe obstetric outcomes in a group of patients with prior cesarean delivery (CD) presenting with an intrauterine fetal demise (IUFD). A secondary analysis of an observational study of women with prior CD was performed. All antepartum singleton pregnancies with a prior CD and IUFD ≥ 20 weeks’ gestation or 500 grams were evaluated. Two hundred nine patients met inclusion criteria for analysis. The mean gestational age ± standard deviation at delivery was 31.3 ± 6.5 weeks. The trial of labor rate was 75.6% (158/209), and the vaginal birth after cesarean (VBAC) success rate was 86.7%. Labor induction or augmentation occurred in 83.3% of attempted VBAC. Uterine rupture occurred in five women (2.4%), and in 3.4% of those being induced but none of these required hysterectomy. Women with a history of previous CD and an IUFD often undergo trial of labor with a high VBAC success rate. Uterine rupture complicates 2.4% of such cases

Maternal and Neonatal Outcomes of Repeat Cesarean Delivery in Women with a Prior Classical versus Low Transverse Uterine Incision

We compared maternal and neonatal outcomes following repeat cesarean delivery (CD) of women with a prior classical CD with those with a prior low transverse CD. The Maternal Fetal Medicine Units (MFMU) Network Cesarean Delivery Registry was used to identify women with one previous CD who underwent an elective repeat CD prior to the onset of labor ≥36 weeks. Outcomes were compared between women with a previous classical CD to those with a prior low transverse CD. Of the 7,936 women who met study criteria, 122 had a prior classical CD. Women with a prior classical CD had a higher rate of classical uterine incision at repeat CD (12.73% versus 0.59%; p < 0.001), had longer total operative time and hospital stay, and had higher intensive care unit admission. Uterine dehiscence was more frequent in women with a prior classical CD (2.46% versus 0.27%, OR 9.35, 95% CI 1.76-31.93). After adjusting for confounding factors, there were no statistical differences in major maternal or neonatal morbidities between groups. Uterine dehiscence was present at repeat CD in 2.46% of women with a prior classical CD. However, major maternal morbidities were similar to those with a prior low transverse CD

Timing of Elective Repeat Cesarean Delivery at Term and Neonatal Outcomes

Because of increased rates of respiratory complications, elective cesarean delivery is discouraged before 39 weeks of gestation unless there is evidence of fetal lung maturity. We assessed associations between elective cesarean delivery at term (37 weeks of gestation or longer) but before 39 weeks of gestation and neonatal outcomes

White’s Classification of Maternal Diabetes and Vaginal Birth After Cesarean Delivery Success in Women Undergoing a Trial of Labor

To estimate the rate of vaginal birth after cesarean delivery (VBAC) success in diabetic women based on White’s Classification

Does Information Available at Admission for Delivery Improve Prediction of Vaginal Birth after Cesarean?

To construct a predictive model for vaginal birth after cesarean (VBAC) that combines factors that can be ascertained only as the pregnancy progresses with those known at initiation of prenatal care

Prediction of uterine rupture associated with attempted vaginal birth after cesarean delivery

To predict individual-specific risk of uterine rupture during an attempted vaginal birth after cesarean (VBAC)

A Randomized, Controlled Trial of Magnesium Sulfate for the Prevention of Cerebral Palsy

Research suggests that fetal exposure to magnesium sulfate before preterm birth might reduce the risk of cerebral palsy