An intervention developed at Laval University makes it possible to offer the right type of delivery, to the right patient, at the right time. Women who have already had a caesarean section can now benefit from an intervention that makes it easier to decide whether to have a vaginal birth or a caesarean section in a subsequent pregnancy. This intervention results in a 28% reduction in serious complications for babies and a 48% reduction in serious complications for mothers, demonstrates an international research team in a study published online December 11 by the journal The Lancet.
"Every year in Canada, 45,000 pregnant women who have already had a C-section have to make a difficult decision: whether to plan another C-section or attempt a vaginal birth. It’s not an easy choice, because both options carry risks for the mother and the child", points out the study’s first author, Nils Chaillet , professor at Laval University’s Faculty of Medicine and researcher at the Centre de recherche du CHU de Québec - Université Laval.
Professor Chaillet and his colleagues from Quebec, the USA and France tested an intervention, called PRISMA, on 10,514 pregnant women who had previously given birth by caesarean section. The incidence of childbirth complications in these women was compared with that of a comparably sized group of women who had also previously given birth by caesarean section, but who did not benefit from the intervention. Participants gave birth in 40 Quebec hospitals between April 2016 and December 2019.
The PRISMA intervention enables the pregnant woman to make a concerted decision with her doctor in the light of information obtained using tools that predict the risk of complications, while promoting a high level of care during childbirth, explains Professor Chaillet. "We use an ultrasound examination to predict the risk of uterine rupture. This predictive tool was developed by Professor Emmanuel Bujold, a professor at Université Laval and co-author of the study published in The Lancet. We also use a tool that predicts the chances of a successful vaginal delivery. The final decision rests with the patients, but we find that the information provided by these tools helps women in their choice based on the evolution of risk factors during pregnancy."
"When you think about it, preventing 28% of serious complications in babies and 48% of serious complications in mothers is major progress. "
-- Nils Chaillet, on the effectiveness of the PRISMA intervention The analyses carried out by the researchers revealed a substantial reduction in the risk of serious complications for children and mothers in the group that benefited from the intervention. "These results were observed without any increase in the caesarean section rate or uterine rupture rate. Women who wanted a vaginal birth but had risk factors ultimately opted, after consultation with their doctor, for a Caesarean section. Other women with no risk factors went the other way. The intervention enables us to offer the right type of delivery, to the right patient, at the right time", sums up Nils Chaillet, to explain the positive effects of the intervention.
"The PRISMA procedure has now been implemented in the 20 hospitals that tested it in our study," continues the researcher. This approach represents an important innovation for women who have already had a caesarean section. When you think about it, preventing 28% of serious complications in babies and 48% of serious complications in mothers is a major advance," he concludes.
