OBJECTIVE: We sought to evaluate the effectiveness and safety of promoting a trial of labor after prior cesarean birth in a community hospital. STUDY DESIGN: A 4-year prospective cohort study was conducted of all patients who had prior cesarean births (N = 1481). A comparison of outcomes was performed between those who elected repeat cesarean delivery (n = 727) and those who attempted a trial of labor after previous cesarean(s) (n = 754). RESULTS: We found that the vaginal birth after cesarean attempt rate was 50.9% and declined significantly during the last 2 years of the study. The elective repeat cesarean rate was 49.1% and increased significantly during the last 2 years of the study. In addition, we found that neonatal outcomes were similar, with the exception of 2 neonatal deaths caused by uterine rupture. Twelve uterine ruptures occurred (1.6%), and 11 of the 12 ruptures involved either induction or augmentation of labor, or both. CONCLUSIONS: A trial of vaginal birth after cesarean is safe provided that induction of labor is not used. The uterine rupture rate of 1.6% is higher than reported in the literature; this may reflect underreporting by community hospitals.
OBJECTIVE: We sought to evaluate the effectiveness and safety of promoting a trial of labor after prior cesarean birth in a community hospital. STUDY DESIGN: A 4-year prospective cohort study was conducted of all patients who had prior cesarean births (N = 1481). A comparison of outcomes was performed between those who elected repeat cesarean delivery (n = 727) and those who attempted a trial of labor after previous cesarean(s) (n = 754). RESULTS: We found that the vaginal birth after cesarean attempt rate was 50.9% and declined significantly during the last 2 years of the study. The elective repeat cesarean rate was 49.1% and increased significantly during the last 2 years of the study. In addition, we found that neonatal outcomes were similar, with the exception of 2 neonatal deaths caused by uterine rupture. Twelve uterine ruptures occurred (1.6%), and 11 of the 12 ruptures involved either induction or augmentation of labor, or both. CONCLUSIONS: A trial of vaginal birth after cesarean is safe provided that induction of labor is not used. The uterine rupture rate of 1.6% is higher than reported in the literature; this may reflect underreporting by community hospitals.
Authors: Sharon A Gilbert; William A Grobman; Mark B Landon; Catherine Y Spong; Dwight J Rouse; Kenneth J Leveno; Michael W Varner; Steve N Caritis; Paul J Meis; Yoram Sorokin; Marshall Carpenter; Mary J O'Sullivan; Baha M Sibai; John M Thorp; Susan M Ramin; Brian M Mercer Journal: Am J Obstet Gynecol Date: 2012-04 Impact factor: 8.661
Authors: Christopher G Fawsitt; Jane Bourke; Richard A Greene; Claire M Everard; Aileen Murphy; Jennifer E Lutomski Journal: PLoS One Date: 2013-03-06 Impact factor: 3.240