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Archives of Gynecology and Obstetrics

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01-11-2007 | Original Article

Once a cesarean always a cesarean? A computer-assisted decision analysis

Authors: Oscar Sadan, Moshe Leshno, Ahuva Gottreich, Abraham Golan, Samuel Lurie

Published in: Archives of Gynecology and Obstetrics | Issue 5/2007

Abstract

Objective

A previous decision analysis models for two strategic choices for trial of labor or repeated cesarean after prior cesarean concluded that the degree of wish for an additional future pregnancy appeared to be a major determinant for choice between the two strategic options. We had extended the analysis model to stillbirth and hypoxic-ischemic encephalopathy in addition to placental complications while updating most of the outcomes in the decision tree.

Study design

A model was formulated using a decision tree based on reported probabilities for various outcomes and estimated utilities. The question asked was should trial of labor or repeated cesarean be performed after a prior cesarean, with a varying desire for an additional pregnancy. The highest expected outcome determines the preference of our model.

Results

Our model favors repeated elective cesarean (0.9947) over trial of labor (0.9917) after a previous cesarean and is the preferred approach. This approach was preferable irrespective of the probability of additional pregnancy.

Conclusion

In contrary to previous models, when taking into account the occurrence of a live infant birth, birth of an infant with hypoxic-ischemic encephalopathy stillbirth, neonatal death, abnormal placental implantation, hysterectomy and maternal death the preferred approach for women with previous cesarean is an elective repeated cesarean rather than trial of vaginal delivery.

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Title: Once a cesarean always a cesarean? A computer-assisted decision analysis
Authors: Oscar Sadan
Moshe Leshno
Ahuva Gottreich
Abraham Golan
Samuel Lurie
Publication date: 01-11-2007
Publisher: Springer-Verlag
Published in: Archives of Gynecology and Obstetrics / Issue 5/2007
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-007-0373-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Once a cesarean always a cesarean? A computer-assisted decision analysis

Abstract

Objective

Study design

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objective

Study design

Results

Conclusion

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