BMJ  2004;328:311 (7 February), doi:10.1136/bmj.37942.546076.44 (published 14 January 2004)

Paper

Outcome of subsequent pregnancy three years after previous operative delivery in the second stage of labour: cohort study

¹ St Michael's Hospital, Bristol BS2 8EG, ² Maternal and Child Health Sciences, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY

Objective To evaluate the reproductive outcome and the mode of delivery in subsequent pregnancies after instrumental vaginal delivery in theatre or caesarean section at full dilatation.

Design Prospective cohort study.

Setting Two urban hospitals with a combined total of 10 000 deliveries a year.

Participants A cohort of 393 women with term, singleton, cephalic pregnancies who needed operative delivery in theatre during the second stage of labour from February 1999 to February 2000. Postal questionnaires were received from 283 women (72%) at three years after the initial delivery.

Main outcome measure Mode of delivery in the subsequent pregnancy.

Results 140 women (49%) achieved a further pregnancy at three years. 91/283 (32%) women wished to avoid a further pregnancy. Women were more likely to aim for vaginal delivery (87% (47/54) v 33% (18/54); adjusted odds ratio 15.55 (95% confidence interval 5.25 to 46.04)) and more likely to have a vaginal delivery (78% (42/54) v 31% (17/54); 9.50 (3.48 to 25.97)) if they had had a previous instrumental vaginal delivery rather than a caesarean section. There was a high rate of vaginal delivery after caesarean section among women who attempted vaginal delivery 17/18 (94%). In both groups, fear of childbirth was a frequently reported reason for avoiding a further pregnancy (51% after instrumental vaginal delivery, 42% after caesarean section; 1.75 (0.58 to 5.25)).

Conclusion Instrumental vaginal delivery offers advantages over caesarean section for future delivery outcomes. The psychological impact of operative delivery requires urgent attention.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Related Articles

Caesarean delivery in the second stage of labour

Chris Spencer, Deirdre Murphy, and Susan Bewley
BMJ 2006 333: 613-614. [Extract] [Full Text] [PDF]

Instrumental delivery makes future vaginal delivery more likely
BMJ 2004 328: 0. [Full Text] [PDF]

This article has been cited by other articles:

• Eijsink, J.J.H., van der Leeuw-Harmsen, L., van der Linden, P.J.Q. (2008). Pregnancy after Caesarean section: fewer or later?. Hum Reprod 23: 543-547 [Abstract] [Full text]  
• Tollanes, M. C., Melve, K. K., Irgens, L. M., Skjaerven, R. (2007). Reduced Fertility After Cesarean Delivery: A Maternal Choice. Obstet Gynecol 110: 1256-1263 [Abstract] [Full text]  
• Spencer, C., Murphy, D., Bewley, S. (2006). Caesarean delivery in the second stage of labour. BMJ 333: 613-614 [Full text]  
• Carter, F. A., Frampton, C. M. A., Mulder, R. T. (2006). Cesarean section and postpartum depression: a review of the evidence examining the link.. Psychosom. Med. 68: 321-330 [Abstract] [Full text]  
• Demissie, K., Rhoads, G. G, Smulian, J. C, Balasubramanian, B. A, Gandhi, K., Joseph, K S, Kramer, M. (2004). Operative vaginal delivery and neonatal and infant adverse outcomes: population based retrospective analysis. BMJ 329: 24- [Abstract] [Full text]  
• Patel, R. R, Murphy, D. J (2004). Forceps delivery in modern obstetric practice. BMJ 328: 1302-1305 [Full text]  
• (2004). Outcome of subsequent pregnancy three years after previous operative delivery in the second stage of labor: cohort study. Obstet Gynecol 103: 992-992 [Full text]