American Journal of Obstetrics and Gynecology
Transactions of the Twenty-Fifth Annual Meeting of the Society for Maternal-Fetal MedicineThe MFMU Cesarean Registry: Factors affecting the success of trial of labor after previous cesarean delivery
Section snippets
Material and methods
The cesarean registry was a 4-year observational study of the National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network designed to address clinical issues related to cesarean childbirth. The study was conducted at 19 academic medical centers; 8 centers participated throughout the study, 5 participated only during the first 2 years and 6 participated for part of the last 2 years. Data were collected for women undergoing attempted vaginal birth after cesarean
Results
During the study period (1999-2002), there were 29,661 women who had a singleton gestation at term with a history of 1 previous cesarean delivery with a transverse or unknown incision. Of these cases, 14,529 (49.0%) underwent trial of labor. Ten thousand six hundred ninety (73.6%) achieved successful VBAC, whereas 3839 (26.4%) failed a TOL. Among those 3839 cases, repeat operation was performed in 2037 (53.1%) for cephalopelvic disproportion/failure to progress dystocia, 1123 (29.3%) for
Comment
Because previous studies have indicated success rates ranging from 60% to 80%, this large multicenter observational cohort study confirms that nearly three fourths of women at term undergoing a trial of labor after previous cesarean section will achieve a successful vaginal delivery.6 Various demographic and clinical characteristics are clearly predictive of VBAC success. Among these factors, we found previous vaginal delivery including successful previous VBAC as the most significant. In our
References (14)
- et al.
Vaginal birth after cesarean delivery: an admission scoring system
Obstet Gynecol
(1997) - et al.
Trial of labor after 40 weeks gestation in women with prior cesarean
Obstet Gynecol
(2001) - et al.
What are the implications for the next delivery in primigravidae who have an elective cesarean section for breech presentation?
BJOG
(2002) - et al.
Labor after previous cesarean: influence of prior indication and parity
Obstet Gynecol
(2000) - et al.
Cost-effectiveness of elective cesarean delivery after one prior low transverse cesarean
Obstet Gynecol
(2000) - et al.
Cost-effectiveness of a trial of labor after previous cesarean
Obstet Gynecol
(2001) - et al.
Births: preliminary data for 2003
Natl Vital Stat Rep
(2003)
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Supported by grants from the National Institute of Child Health and Human Development (HD21410, HD21414, HD27860, HD27861, HD27869, HD27883, HD27889, HD27905, HD27915, HD27917, HD34116, HD34122, HD34136, HD34208, HD34210, HD34136, HD40500, HD40485, HD40544, HD40545, HD40560, HD40512, HD19897, and HD36801).
Presented at the Twenty-Fifth Annual Meeting of the Society for Maternal Fetal Medicine, February 7-12, 2005, Reno, Nev.