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The Mode of delivery of grand multiparous with post-cesarean single uterine scar in low resources settings: A retrospective cohort study

The prevalence of post-caesarean scar uterus, the most important risk factor of uterine rupture is increasing globally. Grand multiparity can also increase the risk of uterine rupture. The issue of grand multiparous with single post caesarean scar is poorly investigated. OBJECTIVES: The purpose of t...

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Autores principales: Valère, Mve Koh, Etienne, Belinga, Phelix Adolphe, Elong, Brice, Toko Fokam, Tebeu, Pierre Marie
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6728743/
https://www.ncbi.nlm.nih.gov/pubmed/31517306
http://dx.doi.org/10.1016/j.eurox.2019.100078
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author Valère, Mve Koh
Etienne, Belinga
Phelix Adolphe, Elong
Brice, Toko Fokam
Tebeu, Pierre Marie
author_facet Valère, Mve Koh
Etienne, Belinga
Phelix Adolphe, Elong
Brice, Toko Fokam
Tebeu, Pierre Marie
author_sort Valère, Mve Koh
collection PubMed
description The prevalence of post-caesarean scar uterus, the most important risk factor of uterine rupture is increasing globally. Grand multiparity can also increase the risk of uterine rupture. The issue of grand multiparous with single post caesarean scar is poorly investigated. OBJECTIVES: The purpose of this study was to assess the factors associated with the mode of delivery of grand multiparous with post caesarean single uterine scar in low resources settings. PATIENTS AND METHOD: It was a retrospective cohort study conducted from the 1(st) January to the 31(st) of May 2016, in three university teaching hospitals of the university of Yaoundé I in Cameroon. Grand multiparous (GMP) defined as parity ≥5 with single post-caesarean lower segment uterine scar admitted at a gestational age of 37 completed weeks and above were compared to grand multiparous without scar uterus at term. GMP with unknown scar were excluded. The mode of delivery and materno-fetal and neonatal outcome were investigated. RESULTS: We included 33 GMP with single lower segment uterine scar and 120 GMP without uterine scar. Induction of labor and acute fetal distress were not related to having a scar or not in grand GMP, but augmentation of labor was less likely to be conducted in case of GMP with scar uterus(p = 0.08). The frequency of vaginal delivery was 75.8 and 87.5% in grand multiparous with and without uterine scar respectively (OR 0.17–1.16; P = 0.085), with one case of instrumental delivery in scarless group. However, single scar multiparity status increased by 2.42 folds the risk of delivery by caesarian section (P = 0.066). Cephalo-pelvic disproportion increased the indication of caesarian section by 12-fold in the GMP with scar group (p = 0.031), but mechanical dystocia related indications (CPD, macrosomia,) were present in only 4 cases out of 8 caesarian sections in the exposed group. The Apgar score at the fifth minute was better in the GMP with scar group. (p = 0.037). CONCLUSION: Grand multiparous with single post-cesarean uterine scar should be given a chance of vaginal delivery in the absence added feto-maternal morbidity.
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spelling pubmed-67287432019-09-12 The Mode of delivery of grand multiparous with post-cesarean single uterine scar in low resources settings: A retrospective cohort study Valère, Mve Koh Etienne, Belinga Phelix Adolphe, Elong Brice, Toko Fokam Tebeu, Pierre Marie Eur J Obstet Gynecol Reprod Biol X Obstetrics and Maternal Fetal Medicine The prevalence of post-caesarean scar uterus, the most important risk factor of uterine rupture is increasing globally. Grand multiparity can also increase the risk of uterine rupture. The issue of grand multiparous with single post caesarean scar is poorly investigated. OBJECTIVES: The purpose of this study was to assess the factors associated with the mode of delivery of grand multiparous with post caesarean single uterine scar in low resources settings. PATIENTS AND METHOD: It was a retrospective cohort study conducted from the 1(st) January to the 31(st) of May 2016, in three university teaching hospitals of the university of Yaoundé I in Cameroon. Grand multiparous (GMP) defined as parity ≥5 with single post-caesarean lower segment uterine scar admitted at a gestational age of 37 completed weeks and above were compared to grand multiparous without scar uterus at term. GMP with unknown scar were excluded. The mode of delivery and materno-fetal and neonatal outcome were investigated. RESULTS: We included 33 GMP with single lower segment uterine scar and 120 GMP without uterine scar. Induction of labor and acute fetal distress were not related to having a scar or not in grand GMP, but augmentation of labor was less likely to be conducted in case of GMP with scar uterus(p = 0.08). The frequency of vaginal delivery was 75.8 and 87.5% in grand multiparous with and without uterine scar respectively (OR 0.17–1.16; P = 0.085), with one case of instrumental delivery in scarless group. However, single scar multiparity status increased by 2.42 folds the risk of delivery by caesarian section (P = 0.066). Cephalo-pelvic disproportion increased the indication of caesarian section by 12-fold in the GMP with scar group (p = 0.031), but mechanical dystocia related indications (CPD, macrosomia,) were present in only 4 cases out of 8 caesarian sections in the exposed group. The Apgar score at the fifth minute was better in the GMP with scar group. (p = 0.037). CONCLUSION: Grand multiparous with single post-cesarean uterine scar should be given a chance of vaginal delivery in the absence added feto-maternal morbidity. Elsevier 2019-07-05 /pmc/articles/PMC6728743/ /pubmed/31517306 http://dx.doi.org/10.1016/j.eurox.2019.100078 Text en © 2019 The Author http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Obstetrics and Maternal Fetal Medicine
Valère, Mve Koh
Etienne, Belinga
Phelix Adolphe, Elong
Brice, Toko Fokam
Tebeu, Pierre Marie
The Mode of delivery of grand multiparous with post-cesarean single uterine scar in low resources settings: A retrospective cohort study
title The Mode of delivery of grand multiparous with post-cesarean single uterine scar in low resources settings: A retrospective cohort study
title_full The Mode of delivery of grand multiparous with post-cesarean single uterine scar in low resources settings: A retrospective cohort study
title_fullStr The Mode of delivery of grand multiparous with post-cesarean single uterine scar in low resources settings: A retrospective cohort study
title_full_unstemmed The Mode of delivery of grand multiparous with post-cesarean single uterine scar in low resources settings: A retrospective cohort study
title_short The Mode of delivery of grand multiparous with post-cesarean single uterine scar in low resources settings: A retrospective cohort study
title_sort mode of delivery of grand multiparous with post-cesarean single uterine scar in low resources settings: a retrospective cohort study
topic Obstetrics and Maternal Fetal Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6728743/
https://www.ncbi.nlm.nih.gov/pubmed/31517306
http://dx.doi.org/10.1016/j.eurox.2019.100078
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