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Mode of birth among women with one previous caesarean section in the Netherlands: a 20-year population-based study
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  • Ian Koorn,
  • Linda Vis,
  • Kim Verschueren,
  • Ageeth Rosman,
  • Thomas van den Akker
Ian Koorn
Amsterdam UMC Locatie AMC

Corresponding Author:[email protected]

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Linda Vis
Perined
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Kim Verschueren
UMC Utrecht
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Ageeth Rosman
Perined
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Thomas van den Akker
Leiden University Medical Center
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Abstract

Objective Describe changes over time regarding mode of birth and perinatal outcomes in women with one previous caesarean section in the Netherlands over the past 20 years. Design Population-based study. Setting Nationwide. Population All women with one previous caesarean section and no previous vaginal birth, who gave birth to a term singleton in cephalic presentation between 2000 and 2019 (n=143,308). Methods Analysis of Dutch perinatal registry data. Main outcome measures Primary: mode of birth per year, intended vaginal birth versus planned caesarean section. Secondary: failed versus successful vaginal birth in case of intended vaginal birth after caesarean (VBAC), and adverse perinatal outcome (perinatal mortality up to 28 days, low Apgar score at 5 minutes, asphyxia, and NICU admission >24 hours). Results A decrease of 21.5% was seen in women with one previous caesarean section intending VBAC in a subsequent pregnancy, from 77.2% in 2000 to 55.7% in 2019, with a marked acceleration from 2009 onwards. The VBAC success rate dropped gradually, from 71.0% to 65.3%. Overall caesarean section rate (planned and unplanned) increased from 45.1% to 63.6%. Adverse perinatal outcomes were higher in women intending VBAC compared to planned caesarean section. However, after an initial decrease, perinatal mortality remained stable from 2009 onwards with only a minimal difference between both modes of birth. Conclusions In the Netherlands, the proportion of women intending VBAC after a previous caesarean section has decreased markedly, particularly from 2009 onwards. This decrease was not accompanied by a synchronous decrease in perinatal mortality after that year.
17 Mar 2022Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
20 Mar 2022Submission Checks Completed
20 Mar 2022Assigned to Editor
21 Mar 2022Reviewer(s) Assigned
22 Apr 2022Review(s) Completed, Editorial Evaluation Pending