Vaginal birth after caesarean section before and during COVID-19 pandemic. Factors associated with successful vaginal birth.

BACKGROUND: The ratio of caesarean has been increasing considerably in many countries. Planning a vaginal birth after a previous caesarean is considered an important option for women in a subsequent pregnancy. AIMS: To analyse obstetric and neonatal outcomes in women in labour after caesarean section before and during the COVID-19 pandemic, and to determine factors associated with successful vaginal birth after caesarean (VBAC). METHODS: Observational cohort study of women in labour with history of caesarean section who gave birth between March 2019 and December 2020 in a tertiary hospital in southern Spain. Consecutive sampling was performed using the maternal birth database and a descriptive and inferential analysis of the study variables was carried out. Socio-demographic, obstetric and neonatal variables were compared between the pre-pandemic and pandemic periods. Multiple logistic regression analysis was performed to determine variables associated with VBAC success. FINDINGS: The VBAC success rate was 67.4%. The caesarean section rate was significantly higher during the COVID-19 pandemic period. Factors associated with VBAC success were: birth before the pandemic (OR 0.32) and at night (OR 0.45), use of epidural analgesia (OR 2.14), and having had a previous vaginal birth (OR 1.98). CONCLUSIONS: The success rate of VBAC was lower during the pandemic. Knowledge of the factors related to VBAC success is critical for practitioners when supporting women in decision-making about mode of birth after a previous caesarean section.

Sociodemographic factors associated with preterm birth and low birth weight: A cross-sectional study.

BACKGROUND: Preterm birth and low birth weight are two public health problems worldwide associated with higher morbidity and perinatal death risk. AIMS: To determine the incidence and socio-demographic factors associated with preterm birth and low birth weight in Spanish women. METHODS: Cross-sectional study with data from women who gave birth in Spain during 2015 extracted from the Statistical Bulletin of births (National Institute Statistics). Records analysed were 331,449. Single births from 22 weeks gestation and fetuses with weight ≥ 500 g were included. Unadjusted and adjusted odd ratios with 95% confidence interval in a multiple logistic regression model were calculated. Variables associated with both health problems were considered dependent variables. FINDINGS: Preterm birth rate in Spain was 6.7% and low birth weight rate was 7.3%. Socio-demographic variables associated with preterm birth were maternal age ≤19 years, immigrant mothers, educational level ≤ secondary studies, and women living in large cities. Low birth weight was related to maternal age ≤19 years and ≥35 years, educational level ≤ secondary studies, and single mothers. Not having previous children and caesarean births were associated with both risks. CONCLUSIONS: The rates of both risks decreased in Spain, one of the countries in Europe where maternal age at having the first child has increased the most and with the lowest birth rate in the world. Maternal age, educational level, maternal nationality, marital status and population size were associated with one or both risks, so the results of this study could be especially relevant to the clinical practice.