|
|
char = P;code = 80
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char = e;code = 101
char = r;code = 114
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char = .;code = 46
result sql = Pregnancy outcome and mode of delivery after a previous operative vaginal delivery.
Pregnancy outcome and mode of delivery after a previous operative vaginal delivery.char = <;code = 60
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char = >;code = 62
char = O;code = 79
char = B;code = 66
char = J;code = 74
char = E;code = 69
char = C;code = 67
char = T;code = 84
char = I;code = 73
char = V;code = 86
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char = :;code = 58
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char = <;code = 60
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char = :;code = 58
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char = T;code = 84
char = o;code = 111
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char = s;code = 115
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char = s;code = 115
char = s;code = 115
char = ;code = 32
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char = n;code = 110
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char = m;code = 109
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char = k;code = 107
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char = r;code = 114
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char = ;code = 32
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char = a;code = 97
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char = e;code = 101
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char = v;code = 118
char = a;code = 97
char = g;code = 103
char = i;code = 105
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char = a;code = 97
char = l;code = 108
char = ;code = 32
char = d;code = 100
char = e;code = 101
char = l;code = 108
char = i;code = 105
char = v;code = 118
char = e;code = 101
char = r;code = 114
char = y;code = 121
char = .;code = 46
char = <;code = 60
char = b;code = 98
char = r;code = 114
char = /;code = 47
char = >;code = 62
char = <;code = 60
char = b;code = 98
char = r;code = 114
char = /;code = 47
char = >;code = 62
char = <;code = 60
char = b;code = 98
char = >;code = 62
char = M;code = 77
char = E;code = 69
char = T;code = 84
char = H;code = 72
char = O;code = 79
char = D;code = 68
char = S;code = 83
char = ;code = 32
char = :;code = 58
char = ;code = 32
char = <;code = 60
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char = T;code = 84
char = h;code = 104
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char = w;code = 119
char = a;code = 97
char = s;code = 115
char = ;code = 32
char = a;code = 97
char = ;code = 32
char = c;code = 99
char = a;code = 97
char = s;code = 115
char = e;code = 101
char = -;code = 45
char = c;code = 99
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char = l;code = 108
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char = ;code = 32
char = a;code = 97
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char = l;code = 108
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char = l;code = 108
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char = a;code = 97
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char = i;code = 105
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char = a;code = 97
char = ;code = 32
char = t;code = 116
char = e;code = 101
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char = i;code = 105
char = a;code = 97
char = r;code = 114
char = y;code = 121
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char = f;code = 102
char = r;code = 114
char = o;code = 111
char = m;code = 109
char = ;code = 32
char = 1;code = 49
char = 9;code = 57
char = 9;code = 57
char = 3;code = 51
char = -;code = 45
char = 2;code = 50
char = 0;code = 48
char = 0;code = 48
char = 6;code = 54
char = ;code = 32
char = (;code = 40
char = n;code = 110
char = =;code = 61
char = 4;code = 52
char = ,;code = 44
char = 1;code = 49
char = 5;code = 53
char = 3;code = 51
char = );code = 41
char = .;code = 46
char = ;code = 32
char = T;code = 84
char = h;code = 104
char = e;code = 101
char = ;code = 32
char = c;code = 99
char = o;code = 111
char = n;code = 110
char = t;code = 116
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char = o;code = 111
char = l;code = 108
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char = a;code = 97
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char = w;code = 119
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char = w;code = 119
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char = d;code = 100
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char = w;code = 119
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char = ;code = 32
char = s;code = 115
char = p;code = 112
char = o;code = 111
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char = t;code = 116
char = a;code = 97
char = n;code = 110
char = e;code = 101
char = o;code = 111
char = u;code = 117
char = s;code = 115
char = ;code = 32
char = v;code = 118
char = a;code = 97
char = g;code = 103
char = i;code = 105
char = n;code = 110
char = a;code = 97
char = l;code = 108
char = ;code = 32
char = d;code = 100
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char = r;code = 114
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char = 3;code = 51
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char = 6;code = 54
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char = T;code = 84
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char = S;code = 83
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char = S;code = 83
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char = <;code = 60
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char = ;code = 32
char = o;code = 111
char = f;code = 102
char = ;code = 32
char = o;code = 111
char = p;code = 112
char = e;code = 101
char = r;code = 114
char = a;code = 97
char = t;code = 116
char = i;code = 105
char = v;code = 118
char = e;code = 101
char = ;code = 32
char = v;code = 118
char = a;code = 97
char = g;code = 103
char = i;code = 105
char = n;code = 110
char = a;code = 97
char = l;code = 108
char = ;code = 32
char = d;code = 100
char = e;code = 101
char = l;code = 108
char = i;code = 105
char = v;code = 118
char = e;code = 101
char = r;code = 114
char = y;code = 121
char = ;code = 32
char = (;code = 40
char = 4;code = 52
char = .;code = 46
char = 7;code = 55
char = %;code = 37
char = ;code = 32
char = c;code = 99
char = o;code = 111
char = m;code = 109
char = p;code = 112
char = a;code = 97
char = r;code = 114
char = e;code = 101
char = d;code = 100
char = ;code = 32
char = w;code = 119
char = i;code = 105
char = t;code = 116
char = h;code = 104
char = ;code = 32
char = 1;code = 49
char = .;code = 46
char = 2;code = 50
char = %;code = 37
char = ,;code = 44
char = ;code = 32
char = P;code = 80
char = <;code = 60
char = .;code = 46
char = 0;code = 48
char = 0;code = 48
char = 6;code = 54
char = );code = 41
char = ;code = 32
char = a;code = 97
char = n;code = 110
char = d;code = 100
char = ;code = 32
char = c;code = 99
char = e;code = 101
char = s;code = 115
char = a;code = 97
char = r;code = 114
char = e;code = 101
char = a;code = 97
char = n;code = 110
char = ;code = 32
char = d;code = 100
char = e;code = 101
char = l;code = 108
char = i;code = 105
char = v;code = 118
char = e;code = 101
char = r;code = 114
char = y;code = 121
char = ;code = 32
char = (;code = 40
char = 8;code = 56
char = .;code = 46
char = 5;code = 53
char = %;code = 37
char = ;code = 32
char = c;code = 99
char = o;code = 111
char = m;code = 109
char = p;code = 112
char = a;code = 97
char = r;code = 114
char = e;code = 101
char = d;code = 100
char = ;code = 32
char = w;code = 119
char = i;code = 105
char = t;code = 116
char = h;code = 104
char = ;code = 32
char = 4;code = 52
char = .;code = 46
char = 6;code = 54
char = %;code = 37
char = ,;code = 44
char = ;code = 32
char = P;code = 80
char = <;code = 60
char = .;code = 46
char = 0;code = 48
char = 0;code = 48
char = 1;code = 49
char = );code = 41
char = ;code = 32
char = i;code = 105
char = n;code = 110
char = ;code = 32
char = t;code = 116
char = h;code = 104
char = e;code = 101
char = ;code = 32
char = s;code = 115
char = u;code = 117
char = b;code = 98
char = s;code = 115
char = e;code = 101
char = q;code = 113
char = u;code = 117
char = e;code = 101
char = n;code = 110
char = t;code = 116
char = ;code = 32
char = p;code = 112
char = r;code = 114
char = e;code = 101
char = g;code = 103
char = n;code = 110
char = a;code = 97
char = n;code = 110
char = c;code = 99
char = y;code = 121
char = .;code = 46
char = ;code = 32
char = T;code = 84
char = h;code = 104
char = e;code = 101
char = ;code = 32
char = r;code = 114
char = a;code = 97
char = t;code = 116
char = e;code = 101
char = ;code = 32
char = o;code = 111
char = f;code = 102
char = ;code = 32
char = n;code = 110
char = e;code = 101
char = o;code = 111
char = n;code = 110
char = a;code = 97
char = t;code = 116
char = a;code = 97
char = l;code = 108
char = ;code = 32
char = b;code = 98
char = i;code = 105
char = r;code = 114
char = t;code = 116
char = h;code = 104
char = ;code = 32
char = i;code = 105
char = n;code = 110
char = j;code = 106
char = u;code = 117
char = r;code = 114
char = y;code = 121
char = ;code = 32
char = (;code = 40
char = 1;code = 49
char = .;code = 46
char = 5;code = 53
char = %;code = 37
char = ;code = 32
char = c;code = 99
char = o;code = 111
char = m;code = 109
char = p;code = 112
char = a;code = 97
char = r;code = 114
char = e;code = 101
char = d;code = 100
char = ;code = 32
char = w;code = 119
char = i;code = 105
char = t;code = 116
char = h;code = 104
char = ;code = 32
char = 0;code = 48
char = .;code = 46
char = 6;code = 54
char = %;code = 37
char = ,;code = 44
char = ;code = 32
char = P;code = 80
char = =;code = 61
char = .;code = 46
char = 0;code = 48
char = 0;code = 48
char = 5;code = 53
char = );code = 41
char = ;code = 32
char = a;code = 97
char = n;code = 110
char = d;code = 100
char = ;code = 32
char = t;code = 116
char = h;code = 104
char = i;code = 105
char = r;code = 114
char = d;code = 100
char = -;code = 45
char = d;code = 100
char = e;code = 101
char = g;code = 103
char = r;code = 114
char = e;code = 101
char = e;code = 101
char = ;code = 32
char = o;code = 111
char = r;code = 114
char = ;code = 32
char = f;code = 102
char = o;code = 111
char = u;code = 117
char = r;code = 114
char = t;code = 116
char = h;code = 104
char = -;code = 45
char = d;code = 100
char = e;code = 101
char = g;code = 103
char = r;code = 114
char = e;code = 101
char = e;code = 101
char = ;code = 32
char = l;code = 108
char = a;code = 97
char = c;code = 99
char = e;code = 101
char = r;code = 114
char = a;code = 97
char = t;code = 116
char = i;code = 105
char = o;code = 111
char = n;code = 110
char = s;code = 115
char = ;code = 32
char = (;code = 40
char = 0;code = 48
char = .;code = 46
char = 7;code = 55
char = %;code = 37
char = ;code = 32
char = c;code = 99
char = o;code = 111
char = m;code = 109
char = p;code = 112
char = a;code = 97
char = r;code = 114
char = e;code = 101
char = d;code = 100
char = ;code = 32
char = w;code = 119
char = i;code = 105
char = t;code = 116
char = h;code = 104
char = ;code = 32
char = 0;code = 48
char = .;code = 46
char = 2;code = 50
char = %;code = 37
char = ,;code = 44
char = ;code = 32
char = P;code = 80
char = =;code = 61
char = .;code = 46
char = 0;code = 48
char = 1;code = 49
char = );code = 41
char = ;code = 32
char = w;code = 119
char = a;code = 97
char = s;code = 115
char = ;code = 32
char = s;code = 115
char = i;code = 105
char = g;code = 103
char = n;code = 110
char = i;code = 105
char = f;code = 102
char = i;code = 105
char = c;code = 99
char = a;code = 97
char = n;code = 110
char = t;code = 116
char = l;code = 108
char = y;code = 121
char = ;code = 32
char = h;code = 104
char = i;code = 105
char = g;code = 103
char = h;code = 104
char = e;code = 101
char = r;code = 114
char = ;code = 32
char = i;code = 105
char = n;code = 110
char = ;code = 32
char = t;code = 116
char = h;code = 104
char = e;code = 101
char = ;code = 32
char = g;code = 103
char = r;code = 114
char = o;code = 111
char = u;code = 117
char = p;code = 112
char = ;code = 32
char = o;code = 111
char = f;code = 102
char = ;code = 32
char = w;code = 119
char = o;code = 111
char = m;code = 109
char = e;code = 101
char = n;code = 110
char = ;code = 32
char = w;code = 119
char = i;code = 105
char = t;code = 116
char = h;code = 104
char = ;code = 32
char = a;code = 97
char = ;code = 32
char = p;code = 112
char = r;code = 114
char = e;code = 101
char = v;code = 118
char = i;code = 105
char = o;code = 111
char = u;code = 117
char = s;code = 115
char = ;code = 32
char = o;code = 111
char = p;code = 112
char = e;code = 101
char = r;code = 114
char = a;code = 97
char = t;code = 116
char = i;code = 105
char = v;code = 118
char = e;code = 101
char = ;code = 32
char = v;code = 118
char = a;code = 97
char = g;code = 103
char = i;code = 105
char = n;code = 110
char = a;code = 97
char = l;code = 108
char = ;code = 32
char = d;code = 100
char = e;code = 101
char = l;code = 108
char = i;code = 105
char = v;code = 118
char = e;code = 101
char = r;code = 114
char = y;code = 121
char = .;code = 46
char = ;code = 32
char = R;code = 82
char = i;code = 105
char = s;code = 115
char = k;code = 107
char = ;code = 32
char = f;code = 102
char = a;code = 97
char = c;code = 99
char = t;code = 116
char = o;code = 111
char = r;code = 114
char = s;code = 115
char = ;code = 32
char = f;code = 102
char = o;code = 111
char = r;code = 114
char = ;code = 32
char = r;code = 114
char = e;code = 101
char = p;code = 112
char = e;code = 101
char = a;code = 97
char = t;code = 116
char = ;code = 32
char = o;code = 111
char = p;code = 112
char = e;code = 101
char = r;code = 114
char = a;code = 97
char = t;code = 116
char = i;code = 105
char = v;code = 118
char = e;code = 101
char = ;code = 32
char = v;code = 118
char = a;code = 97
char = g;code = 103
char = i;code = 105
char = n;code = 110
char = a;code = 97
char = l;code = 108
char = ;code = 32
char = d;code = 100
char = e;code = 101
char = l;code = 108
char = i;code = 105
char = v;code = 118
char = e;code = 101
char = r;code = 114
char = y;code = 121
char = ;code = 32
char = w;code = 119
char = e;code = 101
char = r;code = 114
char = e;code = 101
char = ;code = 32
char = a;code = 97
char = s;code = 115
char = ;code = 32
char = f;code = 102
char = o;code = 111
char = l;code = 108
char = l;code = 108
char = o;code = 111
char = w;code = 119
char = s;code = 115
char = :;code = 58
char = ;code = 32
char = f;code = 102
char = a;code = 97
char = i;code = 105
char = l;code = 108
char = e;code = 101
char = d;code = 100
char = ;code = 32
char = v;code = 118
char = a;code = 97
char = c;code = 99
char = u;code = 117
char = u;code = 117
char = m;code = 109
char = ;code = 32
char = e;code = 101
char = x;code = 120
char = t;code = 116
char = r;code = 114
char = a;code = 97
char = c;code = 99
char = t;code = 116
char = i;code = 105
char = o;code = 111
char = n;code = 110
char = ;code = 32
char = a;code = 97
char = n;code = 110
char = d;code = 100
char = ;code = 32
char = p;code = 112
char = r;code = 114
char = o;code = 111
char = l;code = 108
char = o;code = 111
char = n;code = 110
char = g;code = 103
char = e;code = 101
char = d;code = 100
char = ;code = 32
char = s;code = 115
char = e;code = 101
char = c;code = 99
char = o;code = 111
char = n;code = 110
char = d;code = 100
char = ;code = 32
char = s;code = 115
char = t;code = 116
char = a;code = 97
char = g;code = 103
char = e;code = 101
char = ;code = 32
char = a;code = 97
char = s;code = 115
char = ;code = 32
char = t;code = 116
char = h;code = 104
char = e;code = 101
char = ;code = 32
char = i;code = 105
char = n;code = 110
char = d;code = 100
char = i;code = 105
char = c;code = 99
char = a;code = 97
char = t;code = 116
char = i;code = 105
char = o;code = 111
char = n;code = 110
char = ;code = 32
char = f;code = 102
char = o;code = 111
char = r;code = 114
char = ;code = 32
char = o;code = 111
char = p;code = 112
char = e;code = 101
char = r;code = 114
char = a;code = 97
char = t;code = 116
char = i;code = 105
char = v;code = 118
char = e;code = 101
char = ;code = 32
char = v;code = 118
char = a;code = 97
char = g;code = 103
char = i;code = 105
char = n;code = 110
char = a;code = 97
char = l;code = 108
char = ;code = 32
char = d;code = 100
char = e;code = 101
char = l;code = 108
char = i;code = 105
char = v;code = 118
char = e;code = 101
char = r;code = 114
char = y;code = 121
char = ;code = 32
char = i;code = 105
char = n;code = 110
char = ;code = 32
char = t;code = 116
char = h;code = 104
char = e;code = 101
char = ;code = 32
char = i;code = 105
char = n;code = 110
char = d;code = 100
char = e;code = 101
char = x;code = 120
char = ;code = 32
char = p;code = 112
char = r;code = 114
char = e;code = 101
char = g;code = 103
char = n;code = 110
char = a;code = 97
char = n;code = 110
char = c;code = 99
char = y;code = 121
char = ;;code = 59
char = ;code = 32
char = p;code = 112
char = r;code = 114
char = o;code = 111
char = l;code = 108
char = o;code = 111
char = n;code = 110
char = g;code = 103
char = e;code = 101
char = d;code = 100
char = ;code = 32
char = i;code = 105
char = n;code = 110
char = t;code = 116
char = e;code = 101
char = r;code = 114
char = v;code = 118
char = a;code = 97
char = l;code = 108
char = ;code = 32
char = (;code = 40
char = m;code = 109
char = o;code = 111
char = r;code = 114
char = e;code = 101
char = ;code = 32
char = t;code = 116
char = h;code = 104
char = a;code = 97
char = n;code = 110
char = ;code = 32
char = 3;code = 51
char = ;code = 32
char = y;code = 121
char = e;code = 101
char = a;code = 97
char = r;code = 114
char = s;code = 115
char = );code = 41
char = ;code = 32
char = b;code = 98
char = e;code = 101
char = t;code = 116
char = w;code = 119
char = e;code = 101
char = e;code = 101
char = n;code = 110
char = ;code = 32
char = p;code = 112
char = r;code = 114
char = e;code = 101
char = g;code = 103
char = n;code = 110
char = a;code = 97
char = n;code = 110
char = c;code = 99
char = i;code = 105
char = e;code = 101
char = s;code = 115
char = ;;code = 59
char = ;code = 32
char = h;code = 104
char = i;code = 105
char = g;code = 103
char = h;code = 104
char = e;code = 101
char = r;code = 114
char = ;code = 32
char = f;code = 102
char = e;code = 101
char = t;code = 116
char = a;code = 97
char = l;code = 108
char = ;code = 32
char = w;code = 119
char = e;code = 101
char = i;code = 105
char = g;code = 103
char = h;code = 104
char = t;code = 116
char = ,;code = 44
char = ;code = 32
char = p;code = 112
char = e;code = 101
char = r;code = 114
char = s;code = 115
char = i;code = 105
char = s;code = 115
char = t;code = 116
char = e;code = 101
char = n;code = 110
char = t;code = 116
char = ;code = 32
char = o;code = 111
char = c;code = 99
char = c;code = 99
char = i;code = 105
char = p;code = 112
char = i;code = 105
char = t;code = 116
char = o;code = 111
char = p;code = 112
char = o;code = 111
char = s;code = 115
char = t;code = 116
char = e;code = 101
char = r;code = 114
char = i;code = 105
char = o;code = 111
char = r;code = 114
char = ;code = 32
char = p;code = 112
char = o;code = 111
char = s;code = 115
char = i;code = 105
char = t;code = 116
char = i;code = 105
char = o;code = 111
char = n;code = 110
char = ,;code = 44
char = ;code = 32
char = a;code = 97
char = n;code = 110
char = d;code = 100
char = ;code = 32
char = u;code = 117
char = s;code = 115
char = e;code = 101
char = ;code = 32
char = o;code = 111
char = f;code = 102
char = ;code = 32
char = e;code = 101
char = p;code = 112
char = i;code = 105
char = d;code = 100
char = u;code = 117
char = r;code = 114
char = a;code = 97
char = l;code = 108
char = ;code = 32
char = a;code = 97
char = n;code = 110
char = a;code = 97
char = l;code = 108
char = g;code = 103
char = e;code = 101
char = s;code = 115
char = i;code = 105
char = a;code = 97
char = ;code = 32
char = i;code = 105
char = n;code = 110
char = ;code = 32
char = t;code = 116
char = h;code = 104
char = e;code = 101
char = ;code = 32
char = s;code = 115
char = u;code = 117
char = b;code = 98
char = s;code = 115
char = e;code = 101
char = q;code = 113
char = u;code = 117
char = e;code = 101
char = n;code = 110
char = t;code = 116
char = ;code = 32
char = p;code = 112
char = r;code = 114
char = e;code = 101
char = g;code = 103
char = n;code = 110
char = a;code = 97
char = n;code = 110
char = c;code = 99
char = y;code = 121
char = .;code = 46
char = ;code = 32
char = T;code = 84
char = h;code = 104
char = e;code = 101
char = ;code = 32
char = p;code = 112
char = r;code = 114
char = e;code = 101
char = s;code = 115
char = e;code = 101
char = n;code = 110
char = c;code = 99
char = e;code = 101
char = ;code = 32
char = o;code = 111
char = f;code = 102
char = ;code = 32
char = e;code = 101
char = p;code = 112
char = i;code = 105
char = d;code = 100
char = u;code = 117
char = r;code = 114
char = a;code = 97
char = l;code = 108
char = ;code = 32
char = a;code = 97
char = n;code = 110
char = a;code = 97
char = l;code = 108
char = g;code = 103
char = e;code = 101
char = s;code = 115
char = i;code = 105
char = a;code = 97
char = ;code = 32
char = i;code = 105
char = n;code = 110
char = ;code = 32
char = t;code = 116
char = h;code = 104
char = e;code = 101
char = ;code = 32
char = i;code = 105
char = n;code = 110
char = d;code = 100
char = e;code = 101
char = x;code = 120
char = ;code = 32
char = o;code = 111
char = p;code = 112
char = e;code = 101
char = r;code = 114
char = a;code = 97
char = t;code = 116
char = i;code = 105
char = v;code = 118
char = e;code = 101
char = ;code = 32
char = v;code = 118
char = a;code = 97
char = g;code = 103
char = i;code = 105
char = n;code = 110
char = a;code = 97
char = l;code = 108
char = ;code = 32
char = d;code = 100
char = e;code = 101
char = l;code = 108
char = i;code = 105
char = v;code = 118
char = e;code = 101
char = r;code = 114
char = y;code = 121
char = ;code = 32
char = w;code = 119
char = a;code = 97
char = s;code = 115
char = ;code = 32
char = n;code = 110
char = o;code = 111
char = t;code = 116
char = ;code = 32
char = a;code = 97
char = s;code = 115
char = s;code = 115
char = o;code = 111
char = c;code = 99
char = i;code = 105
char = a;code = 97
char = t;code = 116
char = e;code = 101
char = d;code = 100
char = ;code = 32
char = w;code = 119
char = i;code = 105
char = t;code = 116
char = h;code = 104
char = ;code = 32
char = a;code = 97
char = ;code = 32
char = d;code = 100
char = e;code = 101
char = c;code = 99
char = r;code = 114
char = e;code = 101
char = a;code = 97
char = s;code = 115
char = e;code = 101
char = d;code = 100
char = ;code = 32
char = r;code = 114
char = i;code = 105
char = s;code = 115
char = k;code = 107
char = ;code = 32
char = o;code = 111
char = f;code = 102
char = ;code = 32
char = r;code = 114
char = e;code = 101
char = p;code = 112
char = e;code = 101
char = a;code = 97
char = t;code = 116
char = ;code = 32
char = o;code = 111
char = p;code = 112
char = e;code = 101
char = r;code = 114
char = a;code = 97
char = t;code = 116
char = i;code = 105
char = v;code = 118
char = e;code = 101
char = ;code = 32
char = v;code = 118
char = a;code = 97
char = g;code = 103
char = i;code = 105
char = n;code = 110
char = a;code = 97
char = l;code = 108
char = ;code = 32
char = d;code = 100
char = e;code = 101
char = l;code = 108
char = i;code = 105
char = v;code = 118
char = e;code = 101
char = r;code = 114
char = y;code = 121
char = .;code = 46
char = <;code = 60
char = b;code = 98
char = r;code = 114
char = /;code = 47
char = >;code = 62
char = <;code = 60
char = b;code = 98
char = r;code = 114
char = /;code = 47
char = >;code = 62
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result sql = OBJECTIVE : : To assess pregnancy outcome and risk factors for repeat operative vaginal delivery in women with previous operative vaginal delivery.
METHODS : : This was a case-control study of all nulliparous women who underwent operative vaginal delivery in a tertiary care medical center from 1993-2006 (n=4,153). The control group included nulliparous women who underwent spontaneous vaginal delivery during the same period in a 2:1 ratio (n=8,306). The women in each group who had a subsequent delivery at our center were identified (n=1,396 and n=2,591, respectively), and the outcome of the subsequent delivery was recorded.
RESULTS : : Compared with the women in the spontaneous vaginal delivery group, women who underwent operative vaginal delivery in the index pregnancy had a higher rate of operative vaginal delivery (4.7% compared with 1.2%, P<.006) and cesarean delivery (8.5% compared with 4.6%, P<.001) in the subsequent pregnancy. The rate of neonatal birth injury (1.5% compared with 0.6%, P=.005) and third-degree or fourth-degree lacerations (0.7% compared with 0.2%, P=.01) was significantly higher in the group of women with a previous operative vaginal delivery. Risk factors for repeat operative vaginal delivery were as follows: failed vacuum extraction and prolonged second stage as the indication for operative vaginal delivery in the index pregnancy; prolonged interval (more than 3 years) between pregnancies; higher fetal weight, persistent occipitoposterior position, and use of epidural analgesia in the subsequent pregnancy. The presence of epidural analgesia in the index operative vaginal delivery was not associated with a decreased risk of repeat operative vaginal delivery.
CONCLUSION : : Nulliparous women undergoing operative vaginal delivery are at increased risk of operative vaginal delivery and cesarean delivery in their subsequent pregnancy. Risk stratification based on the identified risk factors may assist clinicians in predicting the likelihood of repeat operative vaginal delivery and in counseling patients accordingly.
LEVEL OF EVIDENCE : : II.
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result sql = Pregnancy outcome and mode of delivery after a previous operative vaginal delivery.
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char = n;code = 110
char = ;code = 32
char = w;code = 119
char = h;code = 104
char = o;code = 111
char = ;code = 32
char = u;code = 117
char = n;code = 110
char = d;code = 100
char = e;code = 101
char = r;code = 114
char = w;code = 119
char = e;code = 101
char = n;code = 110
char = t;code = 116
char = ;code = 32
char = s;code = 115
char = p;code = 112
char = o;code = 111
char = n;code = 110
char = t;code = 116
char = a;code = 97
char = n;code = 110
char = e;code = 101
char = o;code = 111
char = u;code = 117
char = s;code = 115
char = ;code = 32
char = v;code = 118
char = a;code = 97
char = g;code = 103
char = i;code = 105
char = n;code = 110
char = a;code = 97
char = l;code = 108
char = ;code = 32
char = d;code = 100
char = e;code = 101
char = l;code = 108
char = i;code = 105
char = v;code = 118
char = e;code = 101
char = r;code = 114
char = y;code = 121
char = ;code = 32
char = d;code = 100
char = u;code = 117
char = r;code = 114
char = i;code = 105
char = n;code = 110
char = g;code = 103
char = ;code = 32
char = t;code = 116
char = h;code = 104
char = e;code = 101
char = ;code = 32
char = s;code = 115
char = a;code = 97
char = m;code = 109
char = e;code = 101
char = ;code = 32
char = p;code = 112
char = e;code = 101
char = r;code = 114
char = i;code = 105
char = o;code = 111
char = d;code = 100
char = ;code = 32
char = i;code = 105
char = n;code = 110
char = ;code = 32
char = a;code = 97
char = ;code = 32
char = 2;code = 50
char = :;code = 58
char = 1;code = 49
char = ;code = 32
char = r;code = 114
char = a;code = 97
char = t;code = 116
char = i;code = 105
char = o;code = 111
char = ;code = 32
char = (;code = 40
char = n;code = 110
char = =;code = 61
char = 8;code = 56
char = ,;code = 44
char = 3;code = 51
char = 0;code = 48
char = 6;code = 54
char = );code = 41
char = .;code = 46
char = ;code = 32
char = T;code = 84
char = h;code = 104
char = e;code = 101
char = ;code = 32
char = w;code = 119
char = o;code = 111
char = m;code = 109
char = e;code = 101
char = n;code = 110
char = ;code = 32
char = i;code = 105
char = n;code = 110
char = ;code = 32
char = e;code = 101
char = a;code = 97
char = c;code = 99
char = h;code = 104
char = ;code = 32
char = g;code = 103
char = r;code = 114
char = o;code = 111
char = u;code = 117
char = p;code = 112
char = ;code = 32
char = w;code = 119
char = h;code = 104
char = o;code = 111
char = ;code = 32
char = h;code = 104
char = a;code = 97
char = d;code = 100
char = ;code = 32
char = a;code = 97
char = ;code = 32
char = s;code = 115
char = u;code = 117
char = b;code = 98
char = s;code = 115
char = e;code = 101
char = q;code = 113
char = u;code = 117
char = e;code = 101
char = n;code = 110
char = t;code = 116
char = ;code = 32
char = d;code = 100
char = e;code = 101
char = l;code = 108
char = i;code = 105
char = v;code = 118
char = e;code = 101
char = r;code = 114
char = y;code = 121
char = ;code = 32
char = a;code = 97
char = t;code = 116
char = ;code = 32
char = o;code = 111
char = u;code = 117
char = r;code = 114
char = ;code = 32
char = c;code = 99
char = e;code = 101
char = n;code = 110
char = t;code = 116
char = e;code = 101
char = r;code = 114
char = ;code = 32
char = w;code = 119
char = e;code = 101
char = r;code = 114
char = e;code = 101
char = ;code = 32
char = i;code = 105
char = d;code = 100
char = e;code = 101
char = n;code = 110
char = t;code = 116
char = i;code = 105
char = f;code = 102
char = i;code = 105
char = e;code = 101
char = d;code = 100
char = ;code = 32
char = (;code = 40
char = n;code = 110
char = =;code = 61
char = 1;code = 49
char = ,;code = 44
char = 3;code = 51
char = 9;code = 57
char = 6;code = 54
char = ;code = 32
char = a;code = 97
char = n;code = 110
char = d;code = 100
char = ;code = 32
char = n;code = 110
char = =;code = 61
char = 2;code = 50
char = ,;code = 44
char = 5;code = 53
char = 9;code = 57
char = 1;code = 49
char = ,;code = 44
char = ;code = 32
char = r;code = 114
char = e;code = 101
char = s;code = 115
char = p;code = 112
char = e;code = 101
char = c;code = 99
char = t;code = 116
char = i;code = 105
char = v;code = 118
char = e;code = 101
char = l;code = 108
char = y;code = 121
char = );code = 41
char = ,;code = 44
char = ;code = 32
char = a;code = 97
char = n;code = 110
char = d;code = 100
char = ;code = 32
char = t;code = 116
char = h;code = 104
char = e;code = 101
char = ;code = 32
char = o;code = 111
char = u;code = 117
char = t;code = 116
char = c;code = 99
char = o;code = 111
char = m;code = 109
char = e;code = 101
char = ;code = 32
char = o;code = 111
char = f;code = 102
char = ;code = 32
char = t;code = 116
char = h;code = 104
char = e;code = 101
char = ;code = 32
char = s;code = 115
char = u;code = 117
char = b;code = 98
char = s;code = 115
char = e;code = 101
char = q;code = 113
char = u;code = 117
char = e;code = 101
char = n;code = 110
char = t;code = 116
char = ;code = 32
char = d;code = 100
char = e;code = 101
char = l;code = 108
char = i;code = 105
char = v;code = 118
char = e;code = 101
char = r;code = 114
char = y;code = 121
char = ;code = 32
char = w;code = 119
char = a;code = 97
char = s;code = 115
char = ;code = 32
char = r;code = 114
char = e;code = 101
char = c;code = 99
char = o;code = 111
char = r;code = 114
char = d;code = 100
char = e;code = 101
char = d;code = 100
char = .;code = 46
char = <;code = 60
char = b;code = 98
char = r;code = 114
char = /;code = 47
char = >;code = 62
char = <;code = 60
char = b;code = 98
char = r;code = 114
char = /;code = 47
char = >;code = 62
char = <;code = 60
char = b;code = 98
char = >;code = 62
char = R;code = 82
char = E;code = 69
char = S;code = 83
char = U;code = 85
char = L;code = 76
char = T;code = 84
char = S;code = 83
char = ;code = 32
char = :;code = 58
char = ;code = 32
char = <;code = 60
char = /;code = 47
char = b;code = 98
char = >;code = 62
char = :;code = 58
char = ;code = 32
char = C;code = 67
char = o;code = 111
char = m;code = 109
char = p;code = 112
char = a;code = 97
char = r;code = 114
char = e;code = 101
char = d;code = 100
char = ;code = 32
char = w;code = 119
char = i;code = 105
char = t;code = 116
char = h;code = 104
char = ;code = 32
char = t;code = 116
char = h;code = 104
char = e;code = 101
char = ;code = 32
char = w;code = 119
char = o;code = 111
char = m;code = 109
char = e;code = 101
char = n;code = 110
char = ;code = 32
char = i;code = 105
char = n;code = 110
char = ;code = 32
char = t;code = 116
char = h;code = 104
char = e;code = 101
char = ;code = 32
char = s;code = 115
char = p;code = 112
char = o;code = 111
char = n;code = 110
char = t;code = 116
char = a;code = 97
char = n;code = 110
char = e;code = 101
char = o;code = 111
char = u;code = 117
char = s;code = 115
char = ;code = 32
char = v;code = 118
char = a;code = 97
char = g;code = 103
char = i;code = 105
char = n;code = 110
char = a;code = 97
char = l;code = 108
char = ;code = 32
char = d;code = 100
char = e;code = 101
char = l;code = 108
char = i;code = 105
char = v;code = 118
char = e;code = 101
char = r;code = 114
char = y;code = 121
char = ;code = 32
char = g;code = 103
char = r;code = 114
char = o;code = 111
char = u;code = 117
char = p;code = 112
char = ,;code = 44
char = ;code = 32
char = w;code = 119
char = o;code = 111
char = m;code = 109
char = e;code = 101
char = n;code = 110
char = ;code = 32
char = w;code = 119
char = h;code = 104
char = o;code = 111
char = ;code = 32
char = u;code = 117
char = n;code = 110
char = d;code = 100
char = e;code = 101
char = r;code = 114
char = w;code = 119
char = e;code = 101
char = n;code = 110
char = t;code = 116
char = ;code = 32
char = o;code = 111
char = p;code = 112
char = e;code = 101
char = r;code = 114
char = a;code = 97
char = t;code = 116
char = i;code = 105
char = v;code = 118
char = e;code = 101
char = ;code = 32
char = v;code = 118
char = a;code = 97
char = g;code = 103
char = i;code = 105
char = n;code = 110
char = a;code = 97
char = l;code = 108
char = ;code = 32
char = d;code = 100
char = e;code = 101
char = l;code = 108
char = i;code = 105
char = v;code = 118
char = e;code = 101
char = r;code = 114
char = y;code = 121
char = ;code = 32
char = i;code = 105
char = n;code = 110
char = ;code = 32
char = t;code = 116
char = h;code = 104
char = e;code = 101
char = ;code = 32
char = i;code = 105
char = n;code = 110
char = d;code = 100
char = e;code = 101
char = x;code = 120
char = ;code = 32
char = p;code = 112
char = r;code = 114
char = e;code = 101
char = g;code = 103
char = n;code = 110
char = a;code = 97
char = n;code = 110
char = c;code = 99
char = y;code = 121
char = ;code = 32
char = h;code = 104
char = a;code = 97
char = d;code = 100
char = ;code = 32
char = a;code = 97
char = ;code = 32
char = h;code = 104
char = i;code = 105
char = g;code = 103
char = h;code = 104
char = e;code = 101
char = r;code = 114
char = ;code = 32
char = r;code = 114
char = a;code = 97
char = t;code = 116
char = e;code = 101
char = ;code = 32
char = o;code = 111
char = f;code = 102
char = ;code = 32
char = o;code = 111
char = p;code = 112
char = e;code = 101
char = r;code = 114
char = a;code = 97
char = t;code = 116
char = i;code = 105
char = v;code = 118
char = e;code = 101
char = ;code = 32
char = v;code = 118
char = a;code = 97
char = g;code = 103
char = i;code = 105
char = n;code = 110
char = a;code = 97
char = l;code = 108
char = ;code = 32
char = d;code = 100
char = e;code = 101
char = l;code = 108
char = i;code = 105
char = v;code = 118
char = e;code = 101
char = r;code = 114
char = y;code = 121
char = ;code = 32
char = (;code = 40
char = 4;code = 52
char = .;code = 46
char = 7;code = 55
char = %;code = 37
char = ;code = 32
char = c;code = 99
char = o;code = 111
char = m;code = 109
char = p;code = 112
char = a;code = 97
char = r;code = 114
char = e;code = 101
char = d;code = 100
char = ;code = 32
char = w;code = 119
char = i;code = 105
char = t;code = 116
char = h;code = 104
char = ;code = 32
char = 1;code = 49
char = .;code = 46
char = 2;code = 50
char = %;code = 37
char = ,;code = 44
char = ;code = 32
char = P;code = 80
char = <;code = 60
char = .;code = 46
char = 0;code = 48
char = 0;code = 48
char = 6;code = 54
char = );code = 41
char = ;code = 32
char = a;code = 97
char = n;code = 110
char = d;code = 100
char = ;code = 32
char = c;code = 99
char = e;code = 101
char = s;code = 115
char = a;code = 97
char = r;code = 114
char = e;code = 101
char = a;code = 97
char = n;code = 110
char = ;code = 32
char = d;code = 100
char = e;code = 101
char = l;code = 108
char = i;code = 105
char = v;code = 118
char = e;code = 101
char = r;code = 114
char = y;code = 121
char = ;code = 32
char = (;code = 40
char = 8;code = 56
char = .;code = 46
char = 5;code = 53
char = %;code = 37
char = ;code = 32
char = c;code = 99
char = o;code = 111
char = m;code = 109
char = p;code = 112
char = a;code = 97
char = r;code = 114
char = e;code = 101
char = d;code = 100
char = ;code = 32
char = w;code = 119
char = i;code = 105
char = t;code = 116
char = h;code = 104
char = ;code = 32
char = 4;code = 52
char = .;code = 46
char = 6;code = 54
char = %;code = 37
char = ,;code = 44
char = ;code = 32
char = P;code = 80
char = <;code = 60
char = .;code = 46
char = 0;code = 48
char = 0;code = 48
char = 1;code = 49
char = );code = 41
char = ;code = 32
char = i;code = 105
char = n;code = 110
char = ;code = 32
char = t;code = 116
char = h;code = 104
char = e;code = 101
char = ;code = 32
char = s;code = 115
char = u;code = 117
char = b;code = 98
char = s;code = 115
char = e;code = 101
char = q;code = 113
char = u;code = 117
char = e;code = 101
char = n;code = 110
char = t;code = 116
char = ;code = 32
char = p;code = 112
char = r;code = 114
char = e;code = 101
char = g;code = 103
char = n;code = 110
char = a;code = 97
char = n;code = 110
char = c;code = 99
char = y;code = 121
char = .;code = 46
char = ;code = 32
char = T;code = 84
char = h;code = 104
char = e;code = 101
char = ;code = 32
char = r;code = 114
char = a;code = 97
char = t;code = 116
char = e;code = 101
char = ;code = 32
char = o;code = 111
char = f;code = 102
char = ;code = 32
char = n;code = 110
char = e;code = 101
char = o;code = 111
char = n;code = 110
char = a;code = 97
char = t;code = 116
char = a;code = 97
char = l;code = 108
char = ;code = 32
char = b;code = 98
char = i;code = 105
char = r;code = 114
char = t;code = 116
char = h;code = 104
char = ;code = 32
char = i;code = 105
char = n;code = 110
char = j;code = 106
char = u;code = 117
char = r;code = 114
char = y;code = 121
char = ;code = 32
char = (;code = 40
char = 1;code = 49
char = .;code = 46
char = 5;code = 53
char = %;code = 37
char = ;code = 32
char = c;code = 99
char = o;code = 111
char = m;code = 109
char = p;code = 112
char = a;code = 97
char = r;code = 114
char = e;code = 101
char = d;code = 100
char = ;code = 32
char = w;code = 119
char = i;code = 105
char = t;code = 116
char = h;code = 104
char = ;code = 32
char = 0;code = 48
char = .;code = 46
char = 6;code = 54
char = %;code = 37
char = ,;code = 44
char = ;code = 32
char = P;code = 80
char = =;code = 61
char = .;code = 46
char = 0;code = 48
char = 0;code = 48
char = 5;code = 53
char = );code = 41
char = ;code = 32
char = a;code = 97
char = n;code = 110
char = d;code = 100
char = ;code = 32
char = t;code = 116
char = h;code = 104
char = i;code = 105
char = r;code = 114
char = d;code = 100
char = -;code = 45
char = d;code = 100
char = e;code = 101
char = g;code = 103
char = r;code = 114
char = e;code = 101
char = e;code = 101
char = ;code = 32
char = o;code = 111
char = r;code = 114
char = ;code = 32
char = f;code = 102
char = o;code = 111
char = u;code = 117
char = r;code = 114
char = t;code = 116
char = h;code = 104
char = -;code = 45
char = d;code = 100
char = e;code = 101
char = g;code = 103
char = r;code = 114
char = e;code = 101
char = e;code = 101
char = ;code = 32
char = l;code = 108
char = a;code = 97
char = c;code = 99
char = e;code = 101
char = r;code = 114
char = a;code = 97
char = t;code = 116
char = i;code = 105
char = o;code = 111
char = n;code = 110
char = s;code = 115
char = ;code = 32
char = (;code = 40
char = 0;code = 48
char = .;code = 46
char = 7;code = 55
char = %;code = 37
char = ;code = 32
char = c;code = 99
char = o;code = 111
char = m;code = 109
char = p;code = 112
char = a;code = 97
char = r;code = 114
char = e;code = 101
char = d;code = 100
char = ;code = 32
char = w;code = 119
char = i;code = 105
char = t;code = 116
char = h;code = 104
char = ;code = 32
char = 0;code = 48
char = .;code = 46
char = 2;code = 50
char = %;code = 37
char = ,;code = 44
char = ;code = 32
char = P;code = 80
char = =;code = 61
char = .;code = 46
char = 0;code = 48
char = 1;code = 49
char = );code = 41
char = ;code = 32
char = w;code = 119
char = a;code = 97
char = s;code = 115
char = ;code = 32
char = s;code = 115
char = i;code = 105
char = g;code = 103
char = n;code = 110
char = i;code = 105
char = f;code = 102
char = i;code = 105
char = c;code = 99
char = a;code = 97
char = n;code = 110
char = t;code = 116
char = l;code = 108
char = y;code = 121
char = ;code = 32
char = h;code = 104
char = i;code = 105
char = g;code = 103
char = h;code = 104
char = e;code = 101
char = r;code = 114
char = ;code = 32
char = i;code = 105
char = n;code = 110
char = ;code = 32
char = t;code = 116
char = h;code = 104
char = e;code = 101
char = ;code = 32
char = g;code = 103
char = r;code = 114
char = o;code = 111
char = u;code = 117
char = p;code = 112
char = ;code = 32
char = o;code = 111
char = f;code = 102
char = ;code = 32
char = w;code = 119
char = o;code = 111
char = m;code = 109
char = e;code = 101
char = n;code = 110
char = ;code = 32
char = w;code = 119
char = i;code = 105
char = t;code = 116
char = h;code = 104
char = ;code = 32
char = a;code = 97
char = ;code = 32
char = p;code = 112
char = r;code = 114
char = e;code = 101
char = v;code = 118
char = i;code = 105
char = o;code = 111
char = u;code = 117
char = s;code = 115
char = ;code = 32
char = o;code = 111
char = p;code = 112
char = e;code = 101
char = r;code = 114
char = a;code = 97
char = t;code = 116
char = i;code = 105
char = v;code = 118
char = e;code = 101
char = ;code = 32
char = v;code = 118
char = a;code = 97
char = g;code = 103
char = i;code = 105
char = n;code = 110
char = a;code = 97
char = l;code = 108
char = ;code = 32
char = d;code = 100
char = e;code = 101
char = l;code = 108
char = i;code = 105
char = v;code = 118
char = e;code = 101
char = r;code = 114
char = y;code = 121
char = .;code = 46
char = ;code = 32
char = R;code = 82
char = i;code = 105
char = s;code = 115
char = k;code = 107
char = ;code = 32
char = f;code = 102
char = a;code = 97
char = c;code = 99
char = t;code = 116
char = o;code = 111
char = r;code = 114
char = s;code = 115
char = ;code = 32
char = f;code = 102
char = o;code = 111
char = r;code = 114
char = ;code = 32
char = r;code = 114
char = e;code = 101
char = p;code = 112
char = e;code = 101
char = a;code = 97
char = t;code = 116
char = ;code = 32
char = o;code = 111
char = p;code = 112
char = e;code = 101
char = r;code = 114
char = a;code = 97
char = t;code = 116
char = i;code = 105
char = v;code = 118
char = e;code = 101
char = ;code = 32
char = v;code = 118
char = a;code = 97
char = g;code = 103
char = i;code = 105
char = n;code = 110
char = a;code = 97
char = l;code = 108
char = ;code = 32
char = d;code = 100
char = e;code = 101
char = l;code = 108
char = i;code = 105
char = v;code = 118
char = e;code = 101
char = r;code = 114
char = y;code = 121
char = ;code = 32
char = w;code = 119
char = e;code = 101
char = r;code = 114
char = e;code = 101
char = ;code = 32
char = a;code = 97
char = s;code = 115
char = ;code = 32
char = f;code = 102
char = o;code = 111
char = l;code = 108
char = l;code = 108
char = o;code = 111
char = w;code = 119
char = s;code = 115
char = :;code = 58
char = ;code = 32
char = f;code = 102
char = a;code = 97
char = i;code = 105
char = l;code = 108
char = e;code = 101
char = d;code = 100
char = ;code = 32
char = v;code = 118
char = a;code = 97
char = c;code = 99
char = u;code = 117
char = u;code = 117
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char = e;code = 101
char = l;code = 108
char = i;code = 105
char = v;code = 118
char = e;code = 101
char = r;code = 114
char = y;code = 121
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char = n;code = 110
char = ;code = 32
char = t;code = 116
char = h;code = 104
char = e;code = 101
char = i;code = 105
char = r;code = 114
char = ;code = 32
char = s;code = 115
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char = b;code = 98
char = s;code = 115
char = e;code = 101
char = q;code = 113
char = u;code = 117
char = e;code = 101
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char = t;code = 116
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char = a;code = 97
char = n;code = 110
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char = ;code = 32
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char = i;code = 105
char = s;code = 115
char = k;code = 107
char = ;code = 32
char = s;code = 115
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char = r;code = 114
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char = t;code = 116
char = i;code = 105
char = f;code = 102
char = i;code = 105
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char = t;code = 116
char = i;code = 105
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char = n;code = 110
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char = a;code = 97
char = s;code = 115
char = e;code = 101
char = d;code = 100
char = ;code = 32
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char = ;code = 32
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char = e;code = 101
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char = d;code = 100
char = e;code = 101
char = n;code = 110
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char = i;code = 105
char = f;code = 102
char = i;code = 105
char = e;code = 101
char = d;code = 100
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char = s;code = 115
char = k;code = 107
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char = s;code = 115
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char = s;code = 115
char = t;code = 116
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char = i;code = 105
char = n;code = 110
char = i;code = 105
char = c;code = 99
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char = n;code = 110
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char = d;code = 100
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char = i;code = 105
char = n;code = 110
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char = p;code = 112
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char = t;code = 116
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char = i;code = 105
char = n;code = 110
char = ;code = 32
char = c;code = 99
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char = n;code = 110
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char = e;code = 101
char = l;code = 108
char = i;code = 105
char = n;code = 110
char = g;code = 103
char = ;code = 32
char = p;code = 112
char = a;code = 97
char = t;code = 116
char = i;code = 105
char = e;code = 101
char = n;code = 110
char = t;code = 116
char = s;code = 115
char = ;code = 32
char = a;code = 97
char = c;code = 99
char = c;code = 99
char = o;code = 111
char = r;code = 114
char = d;code = 100
char = i;code = 105
char = n;code = 110
char = g;code = 103
char = l;code = 108
char = y;code = 121
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char = <;code = 60
char = b;code = 98
char = r;code = 114
char = /;code = 47
char = >;code = 62
char = <;code = 60
char = b;code = 98
char = r;code = 114
char = /;code = 47
char = >;code = 62
char = <;code = 60
char = b;code = 98
char = >;code = 62
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char = E;code = 69
char = V;code = 86
char = E;code = 69
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char = ;code = 32
char = E;code = 69
char = V;code = 86
char = I;code = 73
char = D;code = 68
char = E;code = 69
char = N;code = 78
char = C;code = 67
char = E;code = 69
char = ;code = 32
char = :;code = 58
char = ;code = 32
char = <;code = 60
char = /;code = 47
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result sql = OBJECTIVE : : To assess pregnancy outcome and risk factors for repeat operative vaginal delivery in women with previous operative vaginal delivery.
METHODS : : This was a case-control study of all nulliparous women who underwent operative vaginal delivery in a tertiary care medical center from 1993-2006 (n=4,153). The control group included nulliparous women who underwent spontaneous vaginal delivery during the same period in a 2:1 ratio (n=8,306). The women in each group who had a subsequent delivery at our center were identified (n=1,396 and n=2,591, respectively), and the outcome of the subsequent delivery was recorded.
RESULTS : : Compared with the women in the spontaneous vaginal delivery group, women who underwent operative vaginal delivery in the index pregnancy had a higher rate of operative vaginal delivery (4.7% compared with 1.2%, P<.006) and cesarean delivery (8.5% compared with 4.6%, P<.001) in the subsequent pregnancy. The rate of neonatal birth injury (1.5% compared with 0.6%, P=.005) and third-degree or fourth-degree lacerations (0.7% compared with 0.2%, P=.01) was significantly higher in the group of women with a previous operative vaginal delivery. Risk factors for repeat operative vaginal delivery were as follows: failed vacuum extraction and prolonged second stage as the indication for operative vaginal delivery in the index pregnancy; prolonged interval (more than 3 years) between pregnancies; higher fetal weight, persistent occipitoposterior position, and use of epidural analgesia in the subsequent pregnancy. The presence of epidural analgesia in the index operative vaginal delivery was not associated with a decreased risk of repeat operative vaginal delivery.
CONCLUSION : : Nulliparous women undergoing operative vaginal delivery are at increased risk of operative vaginal delivery and cesarean delivery in their subsequent pregnancy. Risk stratification based on the identified risk factors may assist clinicians in predicting the likelihood of repeat operative vaginal delivery and in counseling patients accordingly.
LEVEL OF EVIDENCE : : II.
Publication: Obstet Gynecol 2009 Oct ;114(4)::757-63. :doi: 10.1097/AOG.0b013e3181b6f611.
Publication Date: 2009 Oct
Study Author(s): Melamed, Nir;Ben-Haroush, Avi;Chen, Rony;Pardo, Joseph;Hod, Moshe;Yogev, Yariv;
Institution: Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tiqva, Israel. [email protected]
Shortcut link to this study:
Publication Date: 2009 Oct
Study Author(s): Melamed, Nir;Ben-Haroush, Avi;Chen, Rony;Pardo, Joseph;Hod, Moshe;Yogev, Yariv;
Institution: Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tiqva, Israel. [email protected]
Shortcut link to this study:
OBJECTIVE : : To assess pregnancy outcome and risk factors for repeat operative vaginal delivery in women with previous operative vaginal delivery.
METHODS : : This was a case-control study of all nulliparous women who underwent operative vaginal delivery in a tertiary care medical center from 1993-2006 (n=4,153). The control group included nulliparous women who underwent spontaneous vaginal delivery during the same period in a 2:1 ratio (n=8,306). The women in each group who had a subsequent delivery at our center were identified (n=1,396 and n=2,591, respectively), and the outcome of the subsequent delivery was recorded.
RESULTS : : Compared with the women in the spontaneous vaginal delivery group, women who underwent operative vaginal delivery in the index pregnancy had a higher rate of operative vaginal delivery (4.7% compared with 1.2%, P<.006) and cesarean delivery (8.5% compared with 4.6%, P<.001) in the subsequent pregnancy. The rate of neonatal birth injury (1.5% compared with 0.6%, P=.005) and third-degree or fourth-degree lacerations (0.7% compared with 0.2%, P=.01) was significantly higher in the group of women with a previous operative vaginal delivery. Risk factors for repeat operative vaginal delivery were as follows: failed vacuum extraction and prolonged second stage as the indication for operative vaginal delivery in the index pregnancy; prolonged interval (more than 3 years) between pregnancies; higher fetal weight, persistent occipitoposterior position, and use of epidural analgesia in the subsequent pregnancy. The presence of epidural analgesia in the index operative vaginal delivery was not associated with a decreased risk of repeat operative vaginal delivery.
CONCLUSION : : Nulliparous women undergoing operative vaginal delivery are at increased risk of operative vaginal delivery and cesarean delivery in their subsequent pregnancy. Risk stratification based on the identified risk factors may assist clinicians in predicting the likelihood of repeat operative vaginal delivery and in counseling patients accordingly.
LEVEL OF EVIDENCE : : II.
METHODS : : This was a case-control study of all nulliparous women who underwent operative vaginal delivery in a tertiary care medical center from 1993-2006 (n=4,153). The control group included nulliparous women who underwent spontaneous vaginal delivery during the same period in a 2:1 ratio (n=8,306). The women in each group who had a subsequent delivery at our center were identified (n=1,396 and n=2,591, respectively), and the outcome of the subsequent delivery was recorded.
RESULTS : : Compared with the women in the spontaneous vaginal delivery group, women who underwent operative vaginal delivery in the index pregnancy had a higher rate of operative vaginal delivery (4.7% compared with 1.2%, P<.006) and cesarean delivery (8.5% compared with 4.6%, P<.001) in the subsequent pregnancy. The rate of neonatal birth injury (1.5% compared with 0.6%, P=.005) and third-degree or fourth-degree lacerations (0.7% compared with 0.2%, P=.01) was significantly higher in the group of women with a previous operative vaginal delivery. Risk factors for repeat operative vaginal delivery were as follows: failed vacuum extraction and prolonged second stage as the indication for operative vaginal delivery in the index pregnancy; prolonged interval (more than 3 years) between pregnancies; higher fetal weight, persistent occipitoposterior position, and use of epidural analgesia in the subsequent pregnancy. The presence of epidural analgesia in the index operative vaginal delivery was not associated with a decreased risk of repeat operative vaginal delivery.
CONCLUSION : : Nulliparous women undergoing operative vaginal delivery are at increased risk of operative vaginal delivery and cesarean delivery in their subsequent pregnancy. Risk stratification based on the identified risk factors may assist clinicians in predicting the likelihood of repeat operative vaginal delivery and in counseling patients accordingly.
LEVEL OF EVIDENCE : : II.
PMID: 19888032
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