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  • Title: Prediction of successful trial of labor after cesarean - the benefit of prior vaginal delivery.
    Author: Ashwal E, Wertheimer A, Aviram A, Wiznitzer A, Yogev Y, Hiersch L.
    Journal: J Matern Fetal Neonatal Med; 2016; 29(16):2665-70. PubMed ID: 26399162.
    Abstract:
    OBJECTIVE: To determine predictive factors for vaginal birth after cesarean section (VBAC). METHODS: A retrospective cohort study of all women with singleton pregnancies and a prior single low transverse cesarean section (CS) who attempted vaginal delivery in a tertiary hospital (2010-2014). Pregnancy outcome of women with VBAC was compared to those who failed vaginal delivery. Sub-analysis for women with no prior vaginal deliveries was performed. Pregnancies with non-cephalic presentation, estimated fetal weight >4000 g and any contraindications for vaginal delivery were excluded. RESULTS: Of the 40 714 deliveries, 1767 women met inclusion criteria. Among them 1563 (88.5%) had a VBAC and 204 (11.5%) failed. There was no significant difference between the groups regarding maternal age, comorbidities and pregnancy complications. Predictors for VBAC were (odds ratio, 95% confidence interval) interval from prior CS (1.13, 1.04-1.22, p=0.004), previous VBAC (2.77, 1.60-4.78, p < 0.001), prior vaginal delivery prior to the CS (3.05, 1.73-5.39, p < 0.001) and induction of labor (0.62, 0.40-0.97, p = 0.03). For women with no prior vaginal birth, only birthweight was associated with VBAC (0.99, 0.99-1.00, p = 0.02). CONCLUSION: While different variables may influence the rate of VBAC, the predictive ability of VBAC for women with no previous vaginal deliveries remains poor.
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