PD Dr. Mechthild M. Gross, Andrea Matterne Midwife, Head of Midwifery Research and Education Unit...

PD Dr. Mechthild M. Gross, Andrea MatterneMidwife, Head of Midwifery Research and Education UnitDepartment of Obstetrics, Gynaecology and Reproductive Medicine

OptiBIRTHVBAC-Data from Germany

AG Hebammenwissenschaft PD Dr. Mechthild M. Groß

How „old“ are current numbers?

1 U.S. Department of Health and Human Services. Centers for Disease Control and Prevention National Center for Health Statistics National Vital Statistics System. National Vital Statistics Report. Births: Preliminary Data for 2007. Vol 57. Nr.12. 2009 2 U.S. Department of Health and Human Services. Centers for Disease Control and Prevention National Center for Health Statistics National Vital Statistics System. National Vital Statistics Report. Births: Final Data for 2006. Vol 57. Nr.7. 2009 3 Rossi AC, D’Addario V. Maternal morbidity following a trial of labor after cesarean section vs elective repeat cesarean delivery: a systematic review with metaanalysis. AJOG 2008; 199: 224-314The Information Centre for health and social care. Maternity Statistics, England: 2007-08. 2009 http://www.ic.nhs.uk/statistics-and-data-collections/hospital-care/maternity/ nhs-maternity-statistics-england:-2007-08 5 BQS. Basisauswertung Geburtshilfe. http://www.bqs-qualitaetsreport.de/2008/ergebnisse/leistungsbereiche/geburtshilfe/basis6 BQS. Basisauswertung Geburtshilfe. http://www.bqs-outcome.de/2008/ergebnisse/leistungsbereiche/geburtshilfe/buaw/basis/0028_5_G.html7 Zentrum für Qualitätsmanagement. Auswertung Niedersächsische Perinatalstatistik.2008

USA England Germany Lower Saxony

Caesarean-Section Rate 2007 31.8%1 2007 24.6%4 2008 31.6%5 2008 30.9%7

Status Post Caesarean 2008 11.6%6 2008 12.6%7

VBAC – rates =TOL 2006 ~ 8.00%2 2008 47.1%7

Successful – VBAC 73.6%3 2008 67.2%7

Failed - VBAC 2008 32.8%7


The TOP 10 historical factors in pregnancy, Lower Saxony 2008

Parae

%

Allergy 23,1

Hereditary predispositions 17,5

Maternal age > 35 years 14,8

Status post cesarean 12,6

Previous serious illness 10,1

Obesity 8,2

>= 2 previous (spontaneous) abortions 5,3

Other pregnancy related risk factors (anamnestic findings) 5,2

Addiction 4,2

Complications during previous deliveries 5,53

Multiparae

%

Status post cesarean 23,9

Allergy 21,5

Maternal age > 35 years 19,7

Hereditary predispositions 16,2

Previous serious illness 9,2

Obesity 9,0

Complications during previous deliveries 8,7

>= 2 previous (spontaneous) abortions 7,6

Addiction 4,8

Other pregnancy related risk factors (anamnestic findings) 5,53

Centre for Quality and Management in Health Care at the Medical Chamber of Lower Saxony. Perinatal Statistics, 2008


David M Gross MM Wiemer A. Pachaly J Vetter K. Prior cesarean section – an acceptable risk for vaginal delivery at free-standing midwife-led birth centers? Results of the analysis of vaginal birth after cesarean section (VBAC) in German birth centers. EJOGRB 2009;142:106-110Gregory KD, Korst LM, Fridman M, et al. Vaginal birth after cesarean: clinical risk factors associated with adverse outcome. Am J Obstet Gynecol 2008; 198: 452.e1-452-e12.Landon MB et al. The MFMU Cesarean Registry: Factors affecting the success of trial of labor after previous cesarean delivery. Am J Obstet Gynecol. 2005; 193: 1016–234Rossi AC, D’Addario V. Maternal morbidity following a trial of labor after cesarean section vs elective repeat cesarean delivery: a systematic review with metaanalysis. AJOG 2008; 199: 224-31

Sucessful VBAC-Rate: 73%

• 4-year-prospective study 1999 -2002, TOL=14,529, S-VBAC=73.6%, Predictors for S-VBAC were previous vaginal delivery, previous indication not being dystocia, spontaneous labour, birth weight <4000g, Caucasian race (Landon 2005)

• Population based cohort study from 2002, TOL=41,450, S-low-risk-VBAC= 73.76%, S-high-risk-VBAC=50.31% with at least one maternal, fetal, or placental condition (Gregory 2008)

• Metaanalysis, 7 studies, 2000-2007, TOL=24,349, S-VBAC=73%, a higher risk of uterine rupture in women planning VBAC than ERCS is counterbalanced by a reduction of maternal morbidity and hysterectomy when VBAC is successful Rossi (2008)

• Comparison of 364 VBAC with one previous caesarean and 6,448 women with their second labour in birth centres, S-VBAC=73.5% (David 2009)

NIH Consensus Development Conference Statement. Vaginal Birth After Cesarean. Draft Statement, March 26, 2010

“Although TOL rate has declined dramatically over the past several decades, the vaginal delivery rate after TOL has remained constant at approximately 74 percent.”


Collective Data of Lower Saxony and Hessen

Land Annual birth rate (2010)

C-section rate

Women with c-section in history

TOL with c-section in history

ERCS f-VBAC Overall Re-c-section rate

s-VBAC/ all TOL´s

S-VBAC/ women with c-section in history

Lower Saxony

2011

2010

56,532

58.492

33.4%

32,4%

13.8%

25,1%

?

?

51.3%

49.9%

?

21.4%

11.5% (unclear)

12.1%

?

73.6%

27.7%

26,2%

Hessen 48,544 16,488

34%

6,409

13.2%

2,864

44.7%

3545

55.3%

1,094

17.1%

4,639

72.4%

1770

61.8%

1,770

27.6%


Legend of the Table

Federal state

Annual birth rate

C-section rate


SS-Risiko ist Z.n. Sectio as documented in the maternal

record


Die Absicht einer vaginalen Entbindung wird nicht dokumentiert

Some of those may have documented a duration of labour

ERCS

SS-Risiko ist Z.n. Sectio und jetziger Geburtsmodus ist primäre Sectio, Resectio und primäre Sectio nach Misgav-Ladach

f-VBAC

SS-Risiko ist Z.n. Sectio und Sectio mit Geburtsdauer >0 (s. auch Anmerkun

g TOL)

Overall Re-c-section rateAls Geburts-modus „Resectio“ ausgewiesene Geburten, denkbar wäre jedoch hier alle Sectiones bei SS-Risiko Z.n. Sectio zu zählen. Aus vielen Kliniken wissen wir, dass der OPS „Resectio“ gar nicht verwendet wird sondern prim. oder sek. Sectio ausgewählt wird. In den meisten Fällen wird die Resectio eine geplante also prim. Sectio sein.

s-VBAC/ all TOL´s

Mehrgebärende mit SS-Risiko ist Z.n. Sectio und Geburtsdauer > 0 (s. auch Anmerkung TOL)



Overview of Data

Centre Annual birth rate (2010)

C-section rate



ERCS f-VBAC Overall Re-c-section rate

s-VBAC/ all TOL´s


1 2,012

28.3% 10.7% 55.4% 40.9% 35.8%

2 1,670 628

37.6%

181/1670

10.8%

69/181

38.1%

112/181

61.9%

24/69

34.8%

136/181

75.1%

45/69

65.2%

45/181

24.9%

3 2,596 824

31.7%

286/2596

11%

140/286

49%

146/286

51%

55/149

39.3%

201/286

70.3%

85/140

60.7%

85/286

29.7%

4 2,286 625

28.6%

242/2286

10.6%

107/242

44.2%

135/242

55.8%

40/107

37.4%

175/242

72.3%

67/107

62.6%

67/242

27.7%

5 1,995

30.2%

251 (in previous birth)

113/251

45%

80/ 80/251

31.9%


ACOG Practice Bulletin Nr.54 Vaginal Birth After Previous Cesarean Delivery. 2004

The American Academy of Family Physicians. Trial of Labor After Cesarean (TOLAC)

German Society of Obstetrics and Gynecology (DGGG). 2008

Guidelines

1 - USA

3 - Canada

4 - UKRCOGNICE

5 - Germany

SOGC clinical practice guidelines for vaginal birth after previous caesarean birth. 2005

NICE Clinical Practice Algorithm. RCOG Press. 2004

PD Dr. Mechthild M. Gross, Andrea Matterne Midwife, Head of Midwifery Research and Education Unit...

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