Vaginal birth after two previous c-sections: obstetricians-gynaecologists opinions and practice patterns.
OBJECTIVE
To evaluate obstetricians' practice patterns, opinions and factors influencing decision-making about mode of delivery in women with two previous c-sections.


METHODS
A questionnaire was mailed to the 160 obstetricians from the Rhone-Alpes perinatal network. Questionnaires included demographic, organisational information and questions about physicians' opinion, practice patterns and patient counseling concerning vaginal birth after c-section (VBAC) after one and two caesarean sections.


RESULTS
Response rate was 65.6%, 100% and 23.8% would offer VBAC to women with respectively one and two previous c-sections. Uterine rupture rate was largely overestimated in both women with one (2.8%) and two prior c-sections (14.2%). Factors positively influencing obstetricians were cerebral palsy estimated rate less than 20%, a minimal decision to birth delay less than 20 min when emergency c-section would be required. Neonatal severe outcomes consecutive to trial of labour as well as placenta praevia or accreta risk and morbidity associated with multiple c-sections would be insufficiently discussed.


CONCLUSIONS
Obstetricians largely prefer a third planned c-section in women with two previous c-sections. This decision is partly based on a large overestimation of immediate maternal and neonatal serious outcomes consecutive to trial of labour as well documented serious long term outcomes of multiple c-sections are insufficiently considered.
Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Service d'obstétrique, F-69677 Bron, Lyon, France. muriel.doret@chu-lyon.fr
Muriel
M
Doret
Sandrine
S
Touzet
Stephanie
S
Bourdy
Pascal
P
Gaucherand
D000328:Adult; D001291:Attitude of Health Personnel; D002547:Cerebral Palsy / Q000453:epidemiology; D017604:Cesarean Section, Repeat / Q000009:adverse effects; D003376:Counseling; D005260:Female; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009774:Obstetrics / Q000379:methods*; D010921:Placenta Accreta; D010923:Placenta Previa; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014219:Trial of Labor; D014597:Uterine Rupture / Q000453:epidemiology; D016064:Vaginal Birth after Cesarean / Q000009:adverse effects