The MFMU Cesarean Registry: Factors affecting the success of trial of labor after previous cesarean delivery

The purpose of this study was to determine which factors influence the likelihood of successful trial of labor (TOL) after 1 previous cesarean delivery (CD). We performed a multicenter 4-year prospective observational study (1999-2002) of all women with previous CD undergoing TOL. Women with term si...

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Bibliographic Details
Published in:American journal of obstetrics and gynecology 2005-09, Vol.193 (3), p.1016-1023
Main Authors: Landon, Mark B., Leindecker, Sharon, Spong, Catherine Y., Hauth, John C., Bloom, Steven, Varner, Michael W., Moawad, Atef H., Caritis, Steve N., Harper, Margaret, Wapner, Ronald J., Sorokin, Yoram, Miodovnik, Menachem, Carpenter, Marshall, Peaceman, Alan M., O'Sullivan, Mary Jo, Sibai, Baha M., Langer, Oded, Thorp, John M., Ramin, Susan M., Mercer, Brian M., Gabbe, Steven G.
Format: Article
Language:English
Subjects:
Adult
Biological and medical sciences
Cesarean delivery
Cesarean Section, Repeat - statistics & numerical data
Delivery. Postpartum. Lactation
Disorders
Dystocia
Dystocia - epidemiology
Female
Gynecology. Andrology. Obstetrics
Humans
Labor, Induced - statistics & numerical data
Logistic Models
Medical sciences
Odds Ratio
Pregnancy
Pregnancy Outcome
Prospective Studies
Risk Factors
Trial of Labor
Vaginal Birth after Cesarean - statistics & numerical data
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Summary:The purpose of this study was to determine which factors influence the likelihood of successful trial of labor (TOL) after 1 previous cesarean delivery (CD). We performed a multicenter 4-year prospective observational study (1999-2002) of all women with previous CD undergoing TOL. Women with term singleton pregnancies with 1 previous low transverse CD or unknown incision were included for analysis. Fourteen thousand five hundred twenty-nine women underwent TOL, with 10,690 (73.6%) achieving successful VBAC. Women with previous vaginal birth had an 86.6% success rate compared with 60.9% in women without such a history (odds ratio [OR] 4.2; 95% CI 3.8-4.5; P < .001). TOL success rates were affected by previous indication for CD, need for induction or augmentation, cervical dilation on admission, birth weight, race, and maternal body mass index. Multivariate logistic regression analysis identified as predictive of TOL success: previous vaginal delivery (OR 3.9; 95% CI 3.6-4.3), previous indication not being dystocia (CPD/FTP) (OR 1.7; 95% CI 1.5-1.8), spontaneous labor (OR 1.6; 95% CI 1.5-1.8), birth weight
ISSN:0002-9378
1097-6868
DOI:10.1016/j.ajog.2005.05.066