@article {BickfordE158, author = {Celeste D. Bickford and Patricia A. Janssen}, title = {Maternal and newborn outcomes after a prior cesarean birth by planned mode of delivery and history of prior vaginal birth in British Columbia: a retrospective cohort study}, volume = {3}, number = {2}, pages = {E158--E165}, year = {2015}, doi = {10.9778/cmajo.20140055}, publisher = {Canadian Medical Association Open Access Journal}, abstract = {Background As rates for cesarean births continue to rise, more women are faced with the choice to plan a vaginal or a repeat cesarean birth after a previous cesarean. The objective of this population-based retrospective cohort study was to compare the safety of planned vaginal birth with cesarean birth after 1{\textendash}2 previous cesarean sections. Methods We identified singleton term births in British Columbia from 2000 to 2008 using data from the British Columbia Perinatal Data Registry. Women carrying a singleton fetus in cephalic presentation at term (37{\textendash}41 weeks of gestation completed) with 1{\textendash}2 prior cesarean births were included. Those with gestational hypertension, pre-existing diabetes and cardiac disease were excluded. Maternal and neonatal outcomes were classified as either life-threatening or non{\textendash}life threatening. We compared outcomes among women with none versus at least 1 previous vaginal birth, by planned method of delivery. We estimated relative risks (RR) and 95\% confidence intervals (CI) for composite outcomes using Poisson regression. Results Of the 33 812 women in the sample, 5406 had a history of vaginal delivery and 28 406 did not. The composite risk for life-threatening maternal outcomes was elevated among women planning vaginal compared with cesarean birth both with and without a prior vaginal birth (RR 2.06, 95\% CI 1.20{\textendash}3.52) and (2.52, 95\% CI 2.04{\textendash}3.11). Absolute differences (attributable risk [AR]) were 1.01\% and 1.31\% respectively. Non{\textendash}life threatening maternal outcomes were decreased among women planning a vaginal birth if they had had at least 1 prior vaginal delivery (RR 0.51, 95\% CI 0.33{\textendash}0.77; AR 1.17\%). The composite risk of intrapartum stillbirth, neonatal death or life-threatening neonatal outcomes did not differ among women planning vaginal or cesarean birth with a prior vaginal delivery and non{\textendash}life threatening neonatal outcomes were decreased, (RR 0.67, 95\% CI 0.52{\textendash}0.86); AR 1.92\%). Interpretation After 1 or 2 previous cesarean births, risks for adverse outcomes between planned vaginal and cesarean birth are reduced among women with a prior vaginal birth. Our data offer women and their health care providers the opportunity to consider risk profiles separately for women who have and have not had a prior vaginal delivery.}, URL = {https://www.cmajopen.ca/content/3/2/E158}, eprint = {https://www.cmajopen.ca/content/3/2/E158.full.pdf}, journal = {Canadian Medical Association Open Access Journal} }