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. 2014 Dec;41(4):309-15.
doi: 10.1111/birt.12130. Epub 2014 Sep 2.

Vaginal Birth After Cesarean in German Out-Of-Hospital Settings: Maternal and Neonatal Outcomes of Women With Their Second Child

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Vaginal Birth After Cesarean in German Out-Of-Hospital Settings: Maternal and Neonatal Outcomes of Women With Their Second Child

Lea Beckmann et al. Birth. .

Abstract

Background: To offer vaginal birth after cesarean (VBAC) in a hospital setting is recommended in international guidelines, but offering VBAC in out-of-hospital settings is considered controversial. This study describes neonatal and maternal outcomes in mothers who started labor in German out-of-hospital settings.

Method: In a retrospective analysis of German out-of-hospital data from 2005 to 2011, included were 24,545 parae II with a singleton pregnancy in a cephalic presentation at term (1,927 with a prior cesarean and 22,618 with a prior vaginal birth).

Result: The overall VBAC rate was 77.8 percent. The intrapartum transfer rate to hospital was 38.3 percent (prior cesarean) versus 4.6 percent (prior vaginal) (p < 0.05), and the 10-minute Apgar < 7 rate was 0.6 versus 0.2 percent (p < 0.05), and the nonemergency intrapartum transfer rate was 91.5 versus 85.0 percent (p < 0.05). Prolonged first stage of labor was the most common reason for intrapartum transfer in both groups. The leading reason for postpartum transfer was retained placenta.

Discussion: There was a high rate of successful VBAC in this study. The high nonemergency transfer rate for women with VBAC might mean that midwives are more cautious when attending women with a prior cesarean in out-of-hospital settings. Further studies are necessary to evaluate which women are suitable for VBAC in out-of-hospital settings.

Keywords: VBAC; maternal and neonatal outcomes; out-of-hospital setting.

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