Originally Posted by wifeandmom
With VBACs, there were 3 dead moms and 13 dead babies. There were an additional 13 or 14 babies with severe brain damage after VBAC.
With ERCS, there were 7 dead moms and 7 dead babies.
These numbers were taken from the Landon et al(NEJM) study. I have read this study about 20 times since it was published and used it as part of my graduate coursework and thesis on this topic. It is devastating anytime there is a death of a mom or baby. I am in no way trying to make light of these loss but pointing out based on research what these numbers mean.
The study stated that in the maternal mortality category there was 3 women in the VBAC group and 7 in the RCS group. However the study states there is NOT a statistically significant difference between the numbers. However, it was even more interesting to look at the cause of death for these women. In the VBAC group, one woman died of severe preeclampsia with hepatic(liver) failure, one with sickle cell crisis with cardiac arrest, and one with postpartum hemorrhage. Two of the 3 did go on to have a c/s however it did not state which women. The striking thing to me as a researcher is that 2 of these women were even included in the study as most studies exclude women with severe preexisting life-threatening conditions, including the study which started this thread. In the RCS group, the study stated several times that 2 of the 7 deaths were directly attributed the the c/s itself-hemorrhage and anesthesia complications. There were 4 women who died of suspected amniotic fluid embolism. The other women died of an aortic dissection, which depending on the cause could also be considered a preexisting life threatening condition. The number of suspected amniotic fluid embolisms stood out to me. Why? This condition is a sudden event with a very high mortality rate which unlike most other complications does not have a treatment. There were 15801 women in the ECS group with 4 events. The accepted medical incidence of amniotic fluid embolism is 1:20,000-80,000. For a study population of this size there should have been none to maybe 1 statistically. There fact that there was 4 is extremely disturbing and definitely should be investigated further.
Now for the neonatal mortality category. There were 13 infants in the VBAC group and 7 infants in the RCS group. Again the study stated the there was NO STATISTICALLY SIGNIFICANT DIFFERENCE between the two groups. The other category was HIE(brain damage). There were actually 12 infants in this category, 2 of which are also included in the mortality group. In looking at the data, 4 occurred after the mother was induced and 2 occurred after augmentation. There were 7 that occurred after uterine rupture(significant overlap with induction/augmentation). The study also states that the remaining 5 (of 15177 TOLs) that occurred that did not involved uterine rupture was consistent with the medically accepted incidence for both TOL and scheduled RCS.
I tihnk that it is also important to know that this study was NOT based only on women with one prior LTCS at term. This study included women with 1,2,3 and more previous cesarean including in the VBAC group. All women who were at greater than 20 weeks were included. This included 14.1% in the VBAC group and 5% in the RCS group that were preterm(<37 weeks). The study did not state how many deaths/HIE were due to prematurity. In the VBAC group, 3.3% were under 1500 grams and 7.4% were b/w 1501 and 2499 grams while in the RCS group 0.2% were under 1500 grams and 2.7% were b/w 1501 and 2499 grams. There were women included in the study and the rupture rates that had previous classical, low vertical, inverted T, J and unknown incisions also. The use of induction and augmentation medications(pitocin and prostaglandins) were also heavily used. The uterine rupture rate was 0.4% for spontaneous labor, 0.9% for augmented labor and 1% for induced labor.