Predictive score for vaginal birth after cesarean section
ABSTRACT OBJECTIVE: Our purpose was to evaluate the relative weight of the different variables that may influence the chances of vaginal birth after one cesarean delivery, with the aim of developing a predictive score for success of such a trial. STUDY DESIGN: In this retrospective study, which covered a 10-year period (1981 to 1990), 471 women who attempted vaginal birth at a level III university hospital after one abdominal delivery were studied as to the subsequent delivery outcome. An attempt to identify possible prognostic factors for success of such a trial was made. RESULTS: A trial of labor was successful in 368 (78.1%) of women and 103 (21.9%) had a repeat cesarean section. Variables of significant predictive value were vaginal birth before cesarean section (odds ratio 1.8), malpresentation (odds ratio 1.9), pregnancy-induced hypertension (odds ratio 2.3), and Bishop score ≥4 (odds ratio 6.0). Cephalopelvic disproportion and failure to progress did not demonstrate a significant predictive value (odds ratio 0.81) for success or failure in subsequent delivery. In fact, 63.8% of women with this indication have successfully undergone vaginal delivery. Maternal age (odds ratio 0.9) had no bearing on vaginal delivery success rates, whereas both macrosomia (odds ratio 0.2) and intrauterine growth retardation tended to decrease the chances for vaginal birth after cesarean section. CONCLUSIONS: A trial of labor after one cesarean section should be encouraged in most women who are willing to attempt it, provided no obstetric contraindication exists. A scoring system that may help to identify women with a greater chance for vaginal delivery is proposed. (AM J OBSTET GYNECOL 1996;174:192-8.)
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ABSTRACT: Objectives Determination of predictive factors of vaginal delivery in women with a history of caesarean section undergoing a trial of labor. Materials and methods Relevant studies were identified through Medline, and the Cochrane databases 1980–2012. Recommendations from the French and foreign obstetrical societies or colleges have been consulted. Results In France in 2010, a trial of labor was attempted in 49 % with 75 % successful rate (EL2). The site of delivery does not appear to influence the rate of successful trial of labor (EL3). Two factors are strongly associated with vaginal birth after caesarean (VBAC): prior history of vaginal delivery and spontaneous labor (EL2). Many factors appear to decrease the rate of VBAC: maternal age above 40 years (EL3), body mass index greater than 30 kg/m2 (EL3), birth weights greater than 4000 g (EL3), unfortunately, prediction of macrosomia seems to be inaccurate. Induction of labor with pharmacological (prostaglandins and oxytocin) and mechanical methods (Foley catheter) decreased rate of successful VBAC (EL2). The use of pelvimetry to accept or avoid trial of labor, increase the risk of elective caesarean section (EL2) and should therefore not be recommended (grade C). Nomograms are not accurate to predict fail trial of labor as its clinical relevance is limited and has not yet evaluated in French population (expert opinion). Conclusion After caesarean, trial of labor is associated with 75 % successful rate. Two factors are strongly associated with VBAC: a prior history of vaginal delivery and spontaneous labor.Journal de Gynécologie Obstétrique et Biologie de la Reproduction 12/2012; 41(8):735–752. · 0.62 Impact Factor
- Journal of midwifery & women's health 02/2004; 49(1):68–75. · 1.13 Impact Factor
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ABSTRACT: Obstetricians in developing countries appear generally reluctant to conduct vaginal delivery in women with a previous Cesarean because of lack of adequate facilities for optimal fetomaternal monitoring. To describe delivery outcomes among women with one previous Cesarean section at a tertiary hospital in Southeast Nigeria. This was a prospective observational study to determine maternal and perinatal outcomes of attempted vaginal birth after Cesarean sections (VBAC) following one previous Cesarean section. Analysis was done with SPSS statistical software version 17.0 for Windows using descriptive and inferential statistics at 95% level of confidence. Two thousand six hundred and ten women delivered in the center during the study period, of whom 395 had one previous Cesarean section. A total of 370 women with one previous Cesarean section had nonrecurrent indications, of whom 355 consenting pregnant women with one previous Cesarean section were studied. A majority of the women (320/355, 90.1%) preferred to have vaginal delivery despite the one previous Cesarean section. However, only approximately 54% (190/355) were found suitable for trial of VBAC, out of whom 50% (95/190 had successful VBAC. Ninety-five women (50.0%) had failed attempt at VBAC and were delivered by emergency Cesarean section while 35 women (9.8%) had emergency Cesarean section for other obstetric indications (apart from failed VBAC). There was no case of uterine rupture or neonatal and maternal deaths recorded in any group. Apgar scores of less than 7 in the first minute were significantly more frequent amongst women who had vaginal delivery when compared to those who had elective repeat Cesarean section (P=0.03). Most women who had one previous Cesarean delivery chose to undergo trial of VBAC, although only about half were considered suitable for VBAC. The maternal and fetal outcomes of trial of VBAC in selected women with one previous Cesarean delivery for non-recurrent indications were good. Obstetricians in this area should do more to allow VBAC in women with one previous Cesarean section for nonrecurrent indications.International Journal of Women's Health 01/2014; 6:301-5.