Predictive score for vaginal birth after cesarean section
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.)
Available from: Hendrik Gremmels
- "Regarding the order of the caesarean section and the prior vaginal delivery, no data are available on its effect on the rate of uterine rupture. However, higher success rates for TOL are reported after a prior successful VBAC when compared with a vaginal delivery before the caesarean section [14, 32, 33]. It may, therefore, be conceivable that the risk of uterine rupture is lower for women who had a successful delivery after a caesarean section, in comparison to those who had a vaginal delivery prior to the caesarean section. "
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ABSTRACT: To determine the risk of uterine rupture for women undergoing trial of labour (TOL) with both a prior caesarean section (CS) and a vaginal delivery.
A systematic literature search was performed using keywords for CS and uterine rupture. The results were critically appraised and the data from relevant and valid articles were extracted. Odds ratios were calculated and a pooled estimate was determined using the Mantel-Haenszel method.
Five studies were used for final analysis. Three studies showed a significant risk reduction for women with both a previous CS and a prior vaginal delivery (PVD) compared to women with a previous CS only, and two studies showed a trend towards risk reduction. The absolute risk of uterine rupture with a prior vaginal delivery varied from 0.17 to 0.46%. The overall odds ratio for PVD was 0.39 (95% CI 0.29-0.52, P < 0.00001).
Women with a history of both a CS and vaginal delivery are at decreased risk of uterine rupture when undergoing TOL compared with women who have only had a CS.
Available from: Nicolas Cazenave
- "Les résultats de notre étude ont objectivé des faits maintenant reconnus scientifiquement. En effet, tout comme le décrivaient Flamm et Geiger  ou Weinstein et al. , « les chances de succès de l'épreuve du travail sont améliorées par un accouchement antérieur par voie basse » et « une indication autre que la disproportion foetopelvienne pour la première césarienne ». Ces auteurs considèrent également qu'un âge maternel inférieur à 40 ans et un score de Bishop supérieur ou égal à 4 à l'admission sont de bon pronostic. "
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ABSTRACT: To revalue the interest of X-ray pelvimetry and analyse our current management of patients with a previous caesarean delivery.
Case-control retrospective study reviewing 418 case records of women with a scarred uterus: a study group of 206 parturients who delivered in 2002, when X-ray pelvimetry was the rule, compared with a control group of 212 parturients who delivered in 2007, without any X-ray pelvimetry. Outcomes of labour, influence of X-ray pelvimetry, indications of caesarean sections, rates of uterine rupture and neonatal well-being have been analysed.
There was no significant difference between both groups concerning the outcomes of labour. The transverse pelvic diameter is positively correlated with an eutocic delivery and inversely correlated with the rate of caesarean section performed during labour because of obstructed labour. Measurements of the pelvis were unrelated neither to the risk of uterine rupture nor to the neonatal outcome. The risk of uterine rupture is significantly higher when an emergency caesarean section is required.
Our study brings to light a complementary point of view about X-ray pelvimetry. Indeed, our results show that it could be useful in the following of a caesarean section for obstructed labour.
Available from: Nick Raine-Fenning
- "Caesarean section rates are rising and many studies have looked at the propriety of attempting vaginal delivery after previous caesarean section. Some reviews have suggested that the success rates vary according to the reason for the original caesarean   . Lower success rates may be associated with true ''dystocia'' consistent with the traditional classification into 'recurring' and 'non-recurring' indications    . "
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ABSTRACT: To determine whether the pattern of cervical dilatation prior to caesarean section for 'failure to progress' can predict the outcome of subsequent labour.
Single hospital case note review of 171 women delivered by caesarean section for failure to progress and subsequently delivering at the same hospital. Cervicograms were categorized into one of the four patterns by an assessor blinded to the subsequent outcome. Statistical analysis was done by analysis of variance.
The incidence of vaginal delivery did not significantly differ between the groups.
Categorisation of failure to progress by partographic abnormality does not predict subsequent successful vaginal delivery.
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