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Created on : 09 Feb 2004
Modified on : 02 Dec 2007

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Bibliographical entry (without author) :

Outcome of subsequent pregnancy three years after previous operative delivery in the second stage of labour: cohort study. The British Medical Journal 2004;328:311.

Author(s) :

Bahl R, Strachan B, Murphy DJ.

Year of publication :

2004

URL(s) :

http://bmj.bmjjournals.com/cgi/content/full/328/74…

Résumé (français)  :

Abstract (English)  :

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.

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Keywords :

➡ c-section/caesarean ; depression, anxiety ; evidence-based medicine/midwifery ; traumatism ; post-traumatic stress ; psychology ; instrumental delivery

Author of this record :

Cécile Loup — 09 Feb 2004
➡ latest update : Alison Passieux — 02 Dec 2007