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PD Dr. Mechthild M. Gross, Andrea Matterne Midwife, Head of Midwifery Research and Education Unit Department of Obstetrics, Gynaecology and Reproductive.

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Presentation on theme: "PD Dr. Mechthild M. Gross, Andrea Matterne Midwife, Head of Midwifery Research and Education Unit Department of Obstetrics, Gynaecology and Reproductive."— Presentation transcript:

1 PD Dr. Mechthild M. Gross, Andrea Matterne Midwife, Head of Midwifery Research and Education Unit Department of Obstetrics, Gynaecology and Reproductive Medicine OptiBIRTH VBAC-Data from Germany

2 AG Hebammenwissenschaft PD Dr. Mechthild M. Groß How old are current numbers? 1 U.S. Department of Health and Human Services. Centers for Disease Control and Prevention National Center for Health Statistics National Vital Statistics System. National Vital Statistics Report. Births: Preliminary Data for Vol 57. Nr U.S. Department of Health and Human Services. Centers for Disease Control and Prevention National Center for Health Statistics National Vital Statistics System. National Vital Statistics Report. Births: Final Data for Vol 57. Nr Rossi AC, DAddario V. Maternal morbidity following a trial of labor after cesarean section vs elective repeat cesarean delivery: a systematic review with metaanalysis. AJOG 2008; 199: The Information Centre for health and social care. Maternity Statistics, England: nhs-maternity-statistics-england: BQS. Basisauswertung Geburtshilfe. 6 BQS. Basisauswertung Geburtshilfe. 7 Zentrum für Qualitätsmanagement. Auswertung Niedersächsische Perinatalstatistik.2008 USAEnglandGermanyLower Saxony Caesarean-Section Rate % % % % 7 Status Post Caesarean % % 7 VBAC – rates =TOL2006~ 8.00% % 7 Successful – VBAC 73.6% % 7 Failed - VBAC % 7

3 AG Hebammenwissenschaft PD Dr. Mechthild M. Groß The TOP 10 historical factors in pregnancy, Lower Saxony 2008 Parae % Allergy23,1 Hereditary predispositions17,5 Maternal age > 35 years14,8 Status post cesarean12,6 Previous serious illness10,1 Obesity8,2 >= 2 previous (spontaneous) abortions5,3 Other pregnancy related risk factors (anamnestic findings) 5,2 Addiction4,2 Complications during previous deliveries5,53 Multiparae % Status post cesarean23,9 Allergy21,5 Maternal age > 35 years19,7 Hereditary predispositions16,2 Previous serious illness9,2 Obesity9,0 Complications during previous deliveries8,7 >= 2 previous (spontaneous) abortions7,6 Addiction4,8 Other pregnancy related risk factors (anamnestic findings) 5,53 Centre for Quality and Management in Health Care at the Medical Chamber of Lower Saxony. Perinatal Statistics, 2008

4 AG Hebammenwissenschaft PD Dr. Mechthild M. Groß David M Gross MM Wiemer A. Pachaly J Vetter K. Prior cesarean section – an acceptable risk for vaginal delivery at free-standing midwife-led birth centers? Results of the analysis of vaginal birth after cesarean section (VBAC) in German birth centers. EJOGRB 2009;142: Gregory KD, Korst LM, Fridman M, et al. Vaginal birth after cesarean: clinical risk factors associated with adverse outcome. Am J Obstet Gynecol 2008; 198: 452.e1-452-e12. Landon MB et al. The MFMU Cesarean Registry: Factors affecting the success of trial of labor after previous cesarean delivery. Am J Obstet Gynecol. 2005; 193: 1016–234 Rossi AC, DAddario V. Maternal morbidity following a trial of labor after cesarean section vs elective repeat cesarean delivery: a systematic review with metaanalysis. AJOG 2008; 199: Sucessful VBAC-Rate: 73% 4-year-prospective study , TOL=14,529, S-VBAC=73.6%, Predictors for S-VBAC were previous vaginal delivery, previous indication not being dystocia, spontaneous labour, birth weight <4000g, Caucasian race (Landon 2005) Population based cohort study from 2002, TOL=41,450, S-low-risk-VBAC= 73.76%, S-high-risk- VBAC=50.31% with at least one maternal, fetal, or placental condition (Gregory 2008) Metaanalysis, 7 studies, , TOL=24,349, S-VBAC=73%, a higher risk of uterine rupture in women planning VBAC than ERCS is counterbalanced by a reduction of maternal morbidity and hysterectomy when VBAC is successful Rossi (2008) Comparison of 364 VBAC with one previous caesarean and 6,448 women with their second labour in birth centres, S-VBAC=73.5% (David 2009) NIH Consensus Development Conference Statement. Vaginal Birth After Cesarean. Draft Statement, March 26, 2010 Although TOL rate has declined dramatically over the past several decades, the vaginal delivery rate after TOL has remained constant at approximately 74 percent.

5 AG Hebammenwissenschaft PD Dr. Mechthild M. Groß Collective Data of Lower Saxony and Hessen LandAnnual birth rate (2010) C- section rate Women with c- section in history TOL with c- section in history ERCSf-VBACOverall Re-c- section rate s-VBAC/ all TOL´s S-VBAC/ women with c- section in history Lower Saxony , % 32,4% 13.8% 25,1% ???? 51.3% 49.9% ? 21.4% 11.5% (unclear) 12.1% ? 73.6% 27.7% 26,2% Hessen48,54416,488 34% 6, % 2, % % 1, % 4, % % 1, %

6 AG Hebammenwissenschaft PD Dr. Mechthild M. Groß Legend of the Table Federal state Annual birth rate C- section rate Women with c- section in history SS-Risiko ist Z.n. Sectio as documented in the maternal record TOL with c- section in history Die Absicht einer vaginalen Entbindung wird nicht dokumentiert Some of those may have documented a duration of labour ERCS SS-Risiko ist Z.n. Sectio und jetziger Geburtsmod us ist prim ä re Sectio, Resectio und prim ä re Sectio nach Misgav- Ladach f-VBAC SS-Risiko ist Z.n. Sectio und Sectio mit Geburtsdaue r >0 (s. auch Anmerkung TOL) Overall Re-c- section rate Als Geburts- modus Resectio ausgewiesen e Geburten, denkbar w ä re jedoch hier alle Sectiones bei SS- Risiko Z.n. Sectio zu z ä hlen. Aus vielen Kliniken wissen wir, dass der OPS Resectio gar nicht verwendet wird sondern prim. oder sek. Sectio ausgew ä hlt wird. In den meisten F ä llen wird die Resectio eine geplante also prim. Sectio sein. s-VBAC/ all TOL´s Mehrgeb ä ren de mit SS- Risiko ist Z.n. Sectio und Geburtsdaue r > 0 (s. auch Anmerkung TOL) S- VBAC/ women with c- section in history

7 AG Hebammenwissenschaft PD Dr. Mechthild M. Groß Overview of Data CentreAnnual birth rate (2010) C-section rate Women with c- section in history TOL with c-section in history ERCSf-VBACOverall Re-c- section rate s-VBAC/ all TOL´s S-VBAC/ women with c- section in history 12, %10.7%55.4%40.9%35.8% 21, % 181/ % 69/ % 112/ % 24/ % 136/ % 45/ % 45/ % 32, % 286/ % 140/286 49% 146/286 51% 55/ % 201/ % 85/ % 85/ % 42, % 242/ % 107/ % 135/ % 40/ % 175/ % 67/ % 67/ % 51, % 251 (in previous birth) 113/251 45% 80/80/ %

8 AG Hebammenwissenschaft PD Dr. Mechthild M. Groß ACOG Practice Bulletin Nr.54 Vaginal Birth After Previous Cesarean Delivery The American Academy of Family Physicians. Trial of Labor After Cesarean (TOLAC) German Society of Obstetrics and Gynecology (DGGG) Guidelines 1 -USA 3 - Canada 4 - UK RCOG NICE 5 - Germany SOGC clinical practice guidelines for vaginal birth after previous caesarean birth NICE Clinical Practice Algorithm. RCOG Press. 2004


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