Z Geburtshilfe Neonatol 2013; 217 - V13_2
DOI: 10.1055/s-0033-1361269

Delivery mode after previous caesarean section

MM Gross 1, A Matterne 1, S Berlage 2, A Kaiser 3, N Lack 4, S Macher-Heidrich 5, F Bahlmann 6, J Falbrede 7, P Hillemanns 8, C von Kaisenberg 8, F Edler von Koch 9, RL Schild 10, H Stepan 11, B Misselwitz 12
  • 1Medizinische Hochschule Hannover, AG Hebammenwissenschaft, Hannover, Germany
  • 2Zentrum für Qualität und Management im Gesundheitswesen, Hannover, Germany
  • 3Sächsische Landesärztekammer, Dresden, Germany
  • 4Bayrische Arbeitsgemeinschaft für Qualitätssicherung, München, Germany
  • 5Geschäftsstelle Qualitätssicherung NRW, Düsseldorf, Germany
  • 6Bürgerhospital, Frauenklinik, Frankfurt, Germany
  • 7St. Anna Klinik, Frauenklinik, Wuppertal, Germany
  • 8Medizinische Hochschule Hannover, Zentrum für Frauenheilkunde und Geburtshilfe, Hannover, Germany
  • 9Klinikum Dritter Orden, Klinik für Gynäkologie und Geburtshilfe, München-Nymphenburg, Germany
  • 10Diakonische Dienste, Frauenklinik, Hannover, Germany
  • 11Universitätsklinikum, Abteilung für Geburtsmedizin, Leipzig, Germany
  • 12Geschäftsstelle Qualitätssicherung Hessen, Eschborn, Germany

Background: Caesarean and repeat caesarean sections are rising. Mode of delivery after previous caesarean section varies widely, ranging from elective repeat caesarean section (ERCS) and unplanned repeat caesarean section (URCS) after trial of labour (TOL) to vaginal birth after caesarean section (VBAC).

Objective: To describe population-based variations of delivery mode in German multiparous women following previous caesarean section.

Methods: Data for all births in five federal German states (Bavaria, Hesse, Lower Saxony, North Rhine Westphalia and Saxony) from 2011 were analysed. In addition corresponding numbers of six obstetric units participating in the OptiBIRTH study, were included. Following parameters were used: absolute number of births, repeated caesarean section rates, women with previous caesarean section, ERCS, TOL, VBAC and URCS.

Results: The number of births ranged between 33,139 in Saxony and 135,875 in North Rhine Westfalia. The overall c-section rates varied between 22.2% and 34.8%. The proportion of women with previous c-section ranged between 10.5% in Saxony and 15.2% in Hesse, the highest proportion of secundiparae was 30.6%. ERCS ranged between 55.4% in Bavaria and 41.9% in Saxony. URCS after TOL ranged between 43.2% in Hesse and 30.6% in Saxony. The highest overall re-c-section rate was in Hesse (74.6%) and the lowest in Saxony (59.6%). VBAC varied from 56.8% to 69.4% in the federal states and from 56.3% to 72.3% in the six OptiBIRTH units. The VBAC rate of women with previous c-section varied between 26.2% and 40.4% in the federal states and between 25.8 and 32.6% in the six OptiBIRTH units.

Conclusions: Population-based analysis of delivery mode following previous caesarean section reveals patterns offering insight into clinical practice. These results are viewed as extremely helpful when planning interventions aimed at increasing vaginal birth after caesarean section.