Evidence map›Paper›PMID 29735533›Full record

ArticleCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2018

Mode of delivery after a previous cesarean birth, and associated maternal and neonatal morbidity.

Carmen B Young, Shiliang Liu, Giulia M Muraca, Yasser Sabr, Tracy Pressey, Robert M Liston, K S Joseph, Canadian Perinatal Surveillance System

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
16citing papers in PubMed, 2 pooled it
6.7field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

16 citing papers in PubMed, 2 syntheses or guidelines pooled it, 67 citations in OpenAlex.

  1. FIGO good practice recommendations for vaginal birth after cesarean section.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2025
    Guideline
  2. Pooled it
  3. Trial
  4. Maternal morbidity following a trial of labor after cesarean birth: A scoping review of operative vaginal birth compared with cesarean birth in the second stage of labor.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026
    Article
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  8. Hospital factors associated with maternal and neonatal outcomes of deliveries to patients with a previous cesarean delivery: an ecological study.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2023
    Article
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  10. Review
  11. Observational
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  16. Taking a stand for operative vaginal delivery.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2018
    Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors at 3 institutions in 1 country.

Carmen B YoungDepartment of Obstetrics and Gynecology (Young), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta; Maternal, Child and Youth Health Division (Liu), Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Obstetrics and Gynaecology (Muraca, Sabr, Pressey, Liston and Joseph), Faculty of Medicine; School of Population and Public Health (Muraca, Joseph), University of British Columbia; Children and Women's Health Centre of British Columbia (Muraca, Sabr, Pressey, Liston and Joseph), Vancouver, BC; Department of Obstetrics and Gynaecology, College of Medicine, King Saud University, Riyadh, Saudi Arabia (Sabr). cbyoung@ualberta.ca.
Shiliang LiuDepartment of Obstetrics and Gynecology (Young), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta; Maternal, Child and Youth Health Division (Liu), Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Obstetrics and Gynaecology (Muraca, Sabr, Pressey, Liston and Joseph), Faculty of Medicine; School of Population and Public Health (Muraca, Joseph), University of British Columbia; Children and Women's Health Centre of British Columbia (Muraca, Sabr, Pressey, Liston and Joseph), Vancouver, BC; Department of Obstetrics and Gynaecology, College of Medicine, King Saud University, Riyadh, Saudi Arabia (Sabr).
Giulia M MuracaDepartment of Obstetrics and Gynecology (Young), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta; Maternal, Child and Youth Health Division (Liu), Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Obstetrics and Gynaecology (Muraca, Sabr, Pressey, Liston and Joseph), Faculty of Medicine; School of Population and Public Health (Muraca, Joseph), University of British Columbia; Children and Women's Health Centre of British Columbia (Muraca, Sabr, Pressey, Liston and Joseph), Vancouver, BC; Department of Obstetrics and Gynaecology, College of Medicine, King Saud University, Riyadh, Saudi Arabia (Sabr).
Yasser SabrDepartment of Obstetrics and Gynecology (Young), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta; Maternal, Child and Youth Health Division (Liu), Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Obstetrics and Gynaecology (Muraca, Sabr, Pressey, Liston and Joseph), Faculty of Medicine; School of Population and Public Health (Muraca, Joseph), University of British Columbia; Children and Women's Health Centre of British Columbia (Muraca, Sabr, Pressey, Liston and Joseph), Vancouver, BC; Department of Obstetrics and Gynaecology, College of Medicine, King Saud University, Riyadh, Saudi Arabia (Sabr).
Tracy PresseyDepartment of Obstetrics and Gynecology (Young), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta; Maternal, Child and Youth Health Division (Liu), Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Obstetrics and Gynaecology (Muraca, Sabr, Pressey, Liston and Joseph), Faculty of Medicine; School of Population and Public Health (Muraca, Joseph), University of British Columbia; Children and Women's Health Centre of British Columbia (Muraca, Sabr, Pressey, Liston and Joseph), Vancouver, BC; Department of Obstetrics and Gynaecology, College of Medicine, King Saud University, Riyadh, Saudi Arabia (Sabr).
Robert M ListonDepartment of Obstetrics and Gynecology (Young), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta; Maternal, Child and Youth Health Division (Liu), Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Obstetrics and Gynaecology (Muraca, Sabr, Pressey, Liston and Joseph), Faculty of Medicine; School of Population and Public Health (Muraca, Joseph), University of British Columbia; Children and Women's Health Centre of British Columbia (Muraca, Sabr, Pressey, Liston and Joseph), Vancouver, BC; Department of Obstetrics and Gynaecology, College of Medicine, King Saud University, Riyadh, Saudi Arabia (Sabr).
K S JosephDepartment of Obstetrics and Gynecology (Young), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta; Maternal, Child and Youth Health Division (Liu), Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Obstetrics and Gynaecology (Muraca, Sabr, Pressey, Liston and Joseph), Faculty of Medicine; School of Population and Public Health (Muraca, Joseph), University of British Columbia; Children and Women's Health Centre of British Columbia (Muraca, Sabr, Pressey, Liston and Joseph), Vancouver, BC; Department of Obstetrics and Gynaecology, College of Medicine, King Saud University, Riyadh, Saudi Arabia (Sabr).
Canadian Perinatal Surveillance System
University of Alberta · CAChildren's & Women's Health Centre of British Columbia · CAUniversity of British Columbia · CA

Funding

CIHR
6 · The paper itself

Abstract

backgroundThe mode of delivery for women with a previous cesarean delivery remains contentious. We conducted a study comparing maternal and infant outcomes after attempted vaginal birth after cesarean delivery versus elective repeat cesarean delivery.

methodsWe used data from the Discharge Abstract Database that includes all hospital deliveries in Canada (excluding Quebec). In our analysis, we included singleton deliveries to women between 37 and 43 weeks gestation who had a single prior cesarean delivery between April 2003 and March 2015. The primary outcomes were severe maternal morbidity and mortality, and serious neonatal morbidity and mortality. We used logistic regression to estimate adjusted rate ratios (RRs) and 95% confidence intervals (CIs).

resultsAbsolute rates of severe maternal morbidity and mortality were low but significantly higher after attempted vaginal birth after cesarean delivery compared with elective repeat cesarean delivery (10.7 v. 5.65 per 1000 deliveries, respectively; adjusted RR 1.96, 95% CI 1.76 to 2.19). Adjusted rate differences in severe maternal morbidity and mortality, and serious neonatal morbidity and mortality were small (5.42 and 7.09 per 1000 deliveries, respectively; number needed to treat 184 and 141, respectively). The association between vaginal birth after cesarean delivery, and serious neonatal morbidity and mortality showed a temporal worsening (adjusted RR 0.94, 95% CI 0.77 to 1.15 in 2003-2005; adjusted RR 2.07, 95% CI 1.83 to 2.35 in 2012-2014).

interpretationAlthough absolute rates of adverse outcomes are low, attempted vaginal birth after cesarean delivery continues to be associated with higher relative rates of severe morbidity and mortality in mothers and infants. Temporal worsening of infant outcomes after attempted vaginal birth after cesarean delivery highlights the need for greater care in selecting candidates, and more careful monitoring of labour and delivery.

Indexed as

AdultBirth CertificatesCanadaCesarean SectionElective Surgical ProceduresFemaleHumansInfantInfant, NewbornInfant, Newborn, DiseasesMaternal WelfareObstetric Labor ComplicationsPregnancyRisk AssessmentVaginal Birth after Cesarean

Identifiers

PMID29735533
PMCPMC5940456
OpenAlexW2800789005

What OpenQuestion holds

Textmetadata
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.