New procedure could help mothers giving birth after C-section

A newborn baby. (AP Photo/Odelyn Joseph)

A new procedure developed in Quebec could enable women who have had a Caesarean birth to make a more informed decision about their next delivery.

The procedure, known as PRISMA, resulted in a 48 per cent reduction in serious complications for mothers and a 28 per cent reduction in serious complications for babies, according to a study led by a team at Laval University.

"We wanted to show that the right intervention for the right patient at the right time would reduce complications," said the study's author, Nils Chaillet, a professor at Laval University's faculty of medicine and a researcher at the CHU de Québec-Université Laval Research Centre.

It is estimated that every year in Canada, some 45,000 women who have had a Caesarean section will have to decide whether their next delivery will also be by c-section or if they will opt for a vaginal delivery instead.

This can be a difficult decision, as each option carries its own set of risks.

"Some patients who would benefit from a Caesarean section may still be tempted by a vaginal birth," says Chaillet. "Conversely, patients who are good candidates for a vaginal birth may be tempted by a Caesarean section. The new tool will help them to make the right decision."

Chaillet and his colleagues in Quebec, the United States and France tested PRISMA on almost 11,000 pregnant women who had previously given birth by c-section.

The incidence of complications associated with childbirth in these women was compared with that of a similar-sized group made up of women who had also previously given birth by Caesarean section but did not benefit from the procedure.

The study participants gave birth in 40 hospitals in Quebec between 2016 and 2019.

PRISMA uses an ultrasound examination to predict the risk of uterine rupture.

This predictive tool was developed by Emmanuel Bujold, a professor at Université Laval and co-author of the study.

Another tool predicts the chances of a successful vaginal delivery.

All this information enables women, in conjunction with their doctors, to make a more informed decision.

These tools, say the authors, predict the risk of complications while promoting a high level of care during childbirth.

"First we detect the risks, and then we act on the quality of care so that the patient can receive optimal care," said Chaillet.

PRISMA could also remove what the researcher called the "sword of Damocles" hanging over the heads of doctors who embark on a vaginal delivery without knowing whether the patient's uterus will hold up.

Thanks to this new data, "doctors will be able to apply the standards of care they have been shown," said Chaillet.

He says the data will also enable the care team to better determine how patient they can be at the time of delivery: can they afford to let labour continue for a while longer, knowing that the uterus is solid, or should they consider a Caesarean section sooner than they would otherwise have done?

"The results showed that we were able to significantly reduce the baby's severe complications without increasing the risk of Caesarean section or uterine rupture," emphasized Chaillet. "Complications were greatly reduced because we were giving the right intervention to the right patient at the right time."

The PRISMA procedure has now been implemented in the hospitals that tested it as part of the study.

The findings of the study were published in medical journal The Lancet.

-- This report by The Canadian Press was first published in French on Dec. 18, 2023.