The MFMU Cesarean Registry: Factors Affecting the Success of Trial of Labor after Previous Cesarean Delivery

Citation

Landon, Mark B.; Leindecker, Sharon; Spong, Catherine Y.; Hauth, John C.; Bloom, Steven L.; Varner, Michael W.; Moawad, Atef H.; Caritis, Steve N.; Harper, Margaret A.; & Wapner, Ronald J., et al. (2005). The MFMU Cesarean Registry: Factors Affecting the Success of Trial of Labor after Previous Cesarean Delivery. American Journal of Obstetrics & Gynecology, 193(3 Suppl.), 1016-1023.

Abstract

Objective: 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).
Study design: 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.
Results: 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 <4000 g (OR 2.0; 95% CI 1.8-2.3), and Caucasian race (OR 1.8, 95% CI 1.6-1.9) (all P < .001). The overall TOL success rate in obese women (BMI ?30) was lower (68.4%) than in nonobese women (79.6%) (P < .001), and when combined with induction and lack of previous vaginal delivery, successful VBAC occurred in only 44.2% of cases.
Conclusion: Previous vaginal delivery including previous VBAC is the greatest predictor for successful TOL. Previous indication as dystocia, need for labor induction, or a maternal BMI ?30 significantly lowers success rates.

URL

http://dx.doi.org/10.1016/j.ajog.2005.05.066

Reference Type

Journal Article

Year Published

2005

Journal Title

American Journal of Obstetrics & Gynecology

Author(s)

Landon, Mark B.
Leindecker, Sharon
Spong, Catherine Y.
Hauth, John C.
Bloom, Steven L.
Varner, Michael W.
Moawad, Atef H.
Caritis, Steve N.
Harper, Margaret A.
Wapner, Ronald J.
Sorokin, Yoram
Miodovnik, Menachem
Carpenter, Marshall W.
Peaceman, Alan M.
O'Sullivan, Mary Jo
Sibai, Baha M.
Langer, Oded
Thorp, John M., Jr.
Ramin, Susan M.
Mercer, Brian M.
Gabbe, Steven G., for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network

ORCiD

Thorp - 0000-0002-9307-6690