ABSTRACT
OBJECTIVE: To investigate the effect of a quality improvement project with an educational/motivational intervention in northern Italy on the implementation of the trial of labor after cesarean section (CS). METHOD: A pre-post study design was used. Every birth center (n = 23) of the Emilia-Romagna region was included. Gynecologist opinion leaders were first trained about Italian CS recommendations. Barriers to implementation were discussed and shared. Educational/motivational interventions were implemented. Data of multipara with previous CS, with a single, cephalic pregnancy at term, were collected during two periods, before (2012-2014) and after (2017-2019) the intervention (2015-2016). The primary outcome was the rate of vaginal birth after CS (VBAC) and perinatal outcomes. RESULTS: A total of 20 496 women were included. The VBAC rate increased from 18.1% to 23.1% after intervention (P < 0.001). The likelihood of VBAC-adjusted for age 40 years or older, Caucasian, body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) at least 30, previous vaginal delivery, and labor induction-was increased by the intervention by 42% (odds ratio 1.42, 95% confidence interval 1.31-1.54). Neonatal well-being was improved by intervention; neonates requiring resuscitation decreased from 2.1% to 1.6% (P = 0.001). CONCLUSION: Educating and motivating gynecologists toward the trial of labor after CS is worth pursuing. Health quality improvement is demonstrated by increased VBAC even improving neonatal well-being.
Subject(s)
Labor, Obstetric , Vaginal Birth after Cesarean , Infant, Newborn , Female , Pregnancy , Humans , Adult , Trial of Labor , Cesarean Section , Labor, InducedABSTRACT
Objetivos: Determinar si los puntajes de Flamm y Grobman son útiles para predecir el éxito de un parto vaginal en pacientes con cesárea anterior de un hospital general. Diseño: Estudio retrospectivo de tipo comparativo. Institución: Servicio de Obstetricia, Hospital Nacional Cayetano Heredia, Lima, Perú. Participantes: Gestantes a término con historia de cesárea previa. Intervenciones: Se revisó las historias clínicas de las gestantes a término con cesárea anterior que ingresaron en trabajo de parto en forma espontánea por el servicio de emergencia durante el periodo de enero 2010 a diciembre 2011. Se recolectó datos demográficos y obstétricos del ingreso, se aplicó los puntajes de Flamm y Grobman. Principales medidas de resultados: Utilidad de los puntajes en la predicción de parto vaginal en cesareadas previas. Resultados: Durante el periodo de estudio, 398 gestantes con antecedente de cesárea anterior y trabajo de parto espontáneo ingresaron por el servicio de emergencia. Se comparó el área bajo la curva de ROC, la cual fue 0,79 (IC95% 0,74 a 0,82) para la escala de Flamm y 0,74 (IC95% 0,70 a 0,79) para la escala de Grobman, con diferencia estadística (p =0,03). En la comparación de ambos puntajes, el de Flamm fue mejor predictor. Conclusiones: Ambos puntajes demostraron ser útiles para predecir el éxito de un parto vaginal en pacientes con cesárea anterior, siendo el de Flamm mejor predictor.
Objective: To determine if Flamm and Grobman scores are useful to predict successful vaginal delivery in patients with prior cesarean section. Design: Retrospective comparative study. Setting: Obstetrical Service, Hospital Nacional Cayetano Heredia, Lima, Peru. Participants: Term pregnant women with previous cesarean section. Interventions: Medical records of pregnant women at term who had had previous cesarean section and were admitted to the emergency department in spontaneous labor during the period from January 2010 to December 2011 were reviewed. Demographic and obstetrical data were collected and the Flamm and Grobman scores were applied. Main outcome measures: Usefulness of the scores in the prediction of vaginal delivery in women with previous cesarean section. Results: During the study period, 398 pregnant women at term who had a previous cesarean section were admitted to the emergency department in spontaneous labor. We compared the area under the ROC curve 0.79 (95%IC 0.74-0.82) for the Flamm score and 0.74 (95%IC 0.70-0.79) for the Grobman score, with a statistically significant difference (p=0.03). Comparing both, the Flamm score was better predictor. Conclusions: Both scores were useful to predict a successful vaginal delivery in patients who had previous cesarean section, and the Flamm score was a better predictor.
