Neonatal acidemia with trial of labor among parturients with prior cesarean delivery: A case-control study
✍ Scribed by Suneet P. Chauhan; Lisa R. Troyer; Nancy W. Hendrix; James A. Scardo
- Publisher
- John Wiley and Sons
- Year
- 2000
- Tongue
- English
- Weight
- 109 KB
- Volume
- 9
- Category
- Article
- ISSN
- 1057-0802
No coin nor oath required. For personal study only.
✦ Synopsis
Objective:
To determine the risk factors for neonatal acidemia with trial of labor among parturients with a prior cesarean delivery.
Methods:
From a prospectively collected database on all parturients attempting a trial of labor, newborns with umbilical arterial ph < 7.15 were selected as cases and the controls (1:4) were the next four patients who delivered nonacidotic (ph > or = 7.15) neonates. exclusion criteria were no prior cesarean delivery, anomalous fetus, and nonavailability of umbilical arterial blood gas analysis. student's t-test, chi2, and fisher's exact tests were utilized and odds ratio (or) and 95% confidence intervals (ci) were calculated. p < 0.05 was considered significant.
Results:
The frequency of neonatal acidemia among patients undergoing trial of labor was 12% (28/234). the cases and controls (n = 112) were similar (p > 0.05) with regards to maternal age, frequency of more than one prior cesarean delivery (11% vs. 8%), gestational age, cervical exam on admission (3.0 +/- 1.5 vs. 3.4 +/- 1.7 cm), usage of oxytocin, and duration of first or second stage of labor. the mean birthweight was significantly higher among acidotic (3,758 +/- 670 g) than nonacidotic (3,470 +/- 545 g; p = 0.018) newborns. compared to the controls, the cases had a significantly higher frequency of unsuccessful trial of labor (19% vs. 50%; or: 4.09; 95% ci: 1.70, 9.82) and separation of the uterine scar (0.8% vs. 14%; or: 18.50; 95% ci: 1.98, 173.05).
Conclusions:
Acidotic newborns with trial of labor tend to be heavier. parturients have a failed attempt at vaginal birth after cesarean, and have separation of the uterine scar during labor.