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im printing this and taking it with me to the doctor next week and to the hospital.
Vaginal Delivery Can Be Safe After Multiple Cesareans
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By David Douglas
NEW YORK (Reuters Health) Jul 11 - In women attempting vaginal birth after multiple previous cesarean deliveries, the risk of uterine rupture is no greater than in women who have had only one previous cesarean delivery, researchers report in the July issue of Obstetrics and Gynecology.
The author of an accompanying editorial, Dr. Vern L. Katz, from the Center for Genetics and Maternal-Fetal Medicine in Eugene, Oregon, told Reuters Health that this "is exactly the type of evaluation we need to help advise women on the relative safety and relative risks of both repeat cesarean delivery and trials of labor after cesarean. Each woman's situation is specific and advice should be individualized for those specifics."
In the study, Dr. Mark B. Landon of Ohio State University College of Medicine and Public Health, Columbus, and colleagues prospectively examined data for women attempting vaginal birth after a single or multiple cesareans.
Uterine rupture occurred in 9 of 975 women who had had multiple prior cesareans (0.9%) and in 115 of 16,915 women with a single previous cesarean (0.7%), a nonsignificant difference.
However, the rates of hysterectomy were significantly increased in the multiple cesarean group (0.6% versus 0.2%), as were transfusion rates (3.2% versus 1.6%).
Similarly, a composite of maternal morbidity, including endometritis and operative injury, was significantly increased in women who had had multiple cesareans.
Despite this increased risk of complications, the absolute risk is small, the researchers conclude, and "vaginal birth after multiple cesarean deliveries should remain an option."
Dr. Katz added that there is a "shifting paradigm of cesarean, not as an adverse outcome -- a complication -- but as one tool towards achieving the goal of a healthy mother and baby."
"Thus," he concluded, "the studies that we need, like Mark Landon's, help provide guidelines in the best use of the tool."