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Stage of labor at admission among Ugandan women with a prior cesarean, and its impact on management and delivery outcomes
Author(s) -
Boatin Adeline A.,
Agaba Elly,
Nyongozi Baltazar,
Wylie Blair J.
Publication year - 2017
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1002/ijgo.12252
Subject(s) - medicine , obstetrics , odds ratio , confidence interval , referral , cesarean delivery , vaginal delivery , prospective cohort study , gynecology , pregnancy , family medicine , surgery , biology , genetics
Abstract Objective To describe stage of labor at admission among women with a prior cesarean, and examine its impact on intrapartum management and delivery mode. Methods In a prospective cohort study, women admitted to Mbarara Regional Referral Hospital, Uganda, for delivery were enrolled between March and June 2015. Rates of vaginal delivery ( VBAC ) and in‐hospital trial of labor ( TOL ) were compared between early (<4 cm dilation) and late (≥4 cm) presenters. Women were interviewed after delivery about decision making and labor preferences. Results Overall, 188 women comprised the study sample; 98 (52.1%) and 65 (34.6%) women presented at ≥4 cm and ≥6 cm, respectively, and 18 (9.6%) were fully dilated. In‐hospital TOL and VBAC rates were 25.5% (42/165) and 9.6% (18/188), respectively. Compared with early presenters, late presenters were significantly more likely to undergo TOL (28/88 [31.8%] vs 14/77 [18.2%]; odds ratio [ OR ] 2.3, 95% confidence interval [ CI ] 1.1–5.0), and achieve VBAC (16/98 [16.3%] vs 2/90 [2.2%]; OR 7.6, 95% CI 1.7–35.1). Conclusion Most women arrived in active labor, but most had a repeat cesarean. Work is needed to understand the clinical decision making and provider management driving low TOL and VBAC rates.