PLANNED DELIVERY
PREVIOUS CAESAREAN SECTION
Is vaginal delivery acceptable if there has been a previous caesarean section?
Labor Outcomes With Increasing Number of Prior Vaginal Births After Cesarean Delivery.
Mercer BM, Gilbert S, Landon MB, Spong CY, Leveno KJ, Rouse DJ, Varner MW, Moawad AH, Simhan HN, Harper M, Wapner RJ, Sorokin Y, Miodovnik M, Carpenter M, Peaceman A, O'Sullivan MJ, Sibai BM, Langer O, Thorp JM, Ramin SM; for the National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network.
Departments of Obstetrics and Gynecology at Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio; The Ohio State University, Columbus, Ohio; University of Texas Southwestern Medical Center, Dallas, Texas; University of Alabama at Birmingham, Birmingham, Alabama; University of Utah, Salt Lake City, Utah; University of Chicago, Chicago, Illinois; University of Pittsburgh, Pittsburgh, Pennsylvania; Wake Forest University, Winston-Salem, North Carolina; Thomas Jefferson University, Philadelphia, Pennsylvania; Wayne State University, Detroit, Michigan; University of Cincinnati, Cincinnati, Ohio; Columbia University, New York, New York; Brown University, Providence, Rhode Island; Northwestern University, Chicago, Illinois; University of Miami, Miami, Florida; University of Tennessee, Memphis, Tennessee; University of Texas at San Antonio, San Antonio, Texas; University of North Carolina, Chapel Hill, North Carolina; University of Texas at Houston, Houston, Texas; George Washington University Biostatistics Center, Washington, DC, and the National Institute of Child Health and Human Development, Bethesda, Maryland.
Objectives:
To estimate the success rates and risks of an attempted vaginal birth after cesarean delivery (VBAC) according to the number of prior successful VBACs.
Methods:
From a prospective multicenter registry collected at 19 clinical centers from 1999 to 2002, we selected women with one or more prior low transverse cesarean deliveries who attempted a VBAC in the current pregnancy. Outcomes were compared according to the number of prior VBAC attempts subsequent to the last cesarean delivery.
Results:
Among 13,532 women meeting eligibility criteria, VBAC success increased with increasing number of prior VBACs: 63.3%, 87.6%, 90.9%, 90.6%, and 91.6% for those with 0, 1, 2, 3, and 4 or more prior VBACs, respectively (P<.001). The rate of uterine rupture decreased after the first successful VBAC and did not increase thereafter: 0.87%, 0.45%, 0.38%, 0.54%, 0.52% (P=.03). The risk of uterine dehiscence and other peripartum complications also declined statistically after the first successful VBAC. No increase in neonatal morbidities was seen with increasing VBAC number thereafter.
Conclusion:
Women with prior successful VBAC attempts are at low risk for maternal and neonatal complications during subsequent VBAC attempts. An increasing number of prior VBACs is associated with a greater probability of VBAC success, as well as a lower risk of uterine rupture and perinatal complications in the current pregnancy.
Thank you for choosing to visit us.
This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.
I do hope that you find the answers to your women's health questions in the patient information and medical advice provided. If you still have unanswered questions, please consider entering them into one of our forums and I will try to assist you.
