Clint M Cormier1, Mark B Landon, Yinglei Lai, Catherine Y Spong, Dwight J Rouse, Kenneth J Leveno, Michael W Varner, Hyagriv N Simhan, Ronald J Wapner, Yoram Sorokin, Menachem Miodovnik, Marshall Carpenter, Alan M Peaceman, Mary J O'Sullivan, Baha M Sibai, Oded Langer, John M Thorp, Brian M Mercer. 1. From the Departments of Obstetrics and Gynecology University of Texas Health Science Center at Houston, Houston, Texas; The Ohio State University, Columbus, Ohio; University of Alabama at Birmingham, Birmingham Alabama; University of Texas Southwestern Medical Center, Dallas, Texas; University of Utah, Salt Lake City, Utah; University of Pittsburgh, Pittsburgh, Pennsylvania; Thomas Jefferson University, Philadelphia, Pennsylvania; Wayne State University, Detroit, Michigan; University of Cincinnati, Cincinnati, Ohio; Columbia University, New York, New York; Brown University, Providence, Rhode Island; Northwestern University, Chicago, Illinois; University of Miami, Miami, Florida; University of Tennessee, Memphis, Tennessee; University of Texas Health Science Center at San Antonio, San Antonio, Texas; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Case Western Reserve University Cleveland, Ohio, The George Washington University Biostatistics Center, Washington, DC, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
Abstract
OBJECTIVE: To estimate the rate of vaginal birth after cesarean delivery (VBAC) success in diabetic women based on White's Classification. METHODS: This is a secondary analysis of an observational study conducted at 19 medical centers of women attempting VBAC. Diabetic women with singleton gestations, one prior cesarean delivery, and cephalic presentation who underwent a trial of labor were included. Vaginal birth after cesarean delivery success rates and maternal and neonatal complications were compared based on White's Classification. RESULTS: Of 11,856 women who underwent trial of labor, 624 met all study criteria (class A1, 356; A2, 169; B, 70; C, 21; D/R/F, 8). Vaginal birth after cesarean delivery success in each group was: A1, 68.5% (95% confidence interval [CI] 63.4-73.3%); A2, 55% (95% CI 47.2-62.7%); B, 70% (95% CI 57.9-80.4%); C, 47.6% (95% CI 25.7-70.2%); and D/F/R, 12.5% (95% CI 0.3-52.7%). Maternal and neonatal complications were rare and not found to be different among groups. CONCLUSION: Our study provides estimates for VBAC success based on White's classification and indicates a relatively low rate of perinatal complications after VBAC attempt for diabetic women. LEVEL OF EVIDENCE: III.
OBJECTIVE: To estimate the rate of vaginal birth after cesarean delivery (VBAC) success in diabeticwomen based on White's Classification. METHODS: This is a secondary analysis of an observational study conducted at 19 medical centers of women attempting VBAC. Diabeticwomen with singleton gestations, one prior cesarean delivery, and cephalic presentation who underwent a trial of labor were included. Vaginal birth after cesarean delivery success rates and maternal and neonatal complications were compared based on White's Classification. RESULTS: Of 11,856 women who underwent trial of labor, 624 met all study criteria (class A1, 356; A2, 169; B, 70; C, 21; D/R/F, 8). Vaginal birth after cesarean delivery success in each group was: A1, 68.5% (95% confidence interval [CI] 63.4-73.3%); A2, 55% (95% CI 47.2-62.7%); B, 70% (95% CI 57.9-80.4%); C, 47.6% (95% CI 25.7-70.2%); and D/F/R, 12.5% (95% CI 0.3-52.7%). Maternal and neonatal complications were rare and not found to be different among groups. CONCLUSION: Our study provides estimates for VBAC success based on White's classification and indicates a relatively low rate of perinatal complications after VBAC attempt for diabeticwomen. LEVEL OF EVIDENCE: III.
Authors: Mark B Landon; John C Hauth; Kenneth J Leveno; Catherine Y Spong; Sharon Leindecker; Michael W Varner; Atef H Moawad; Steve N Caritis; Margaret Harper; Ronald J Wapner; Yoram Sorokin; Menachem Miodovnik; Marshall Carpenter; Alan M Peaceman; Mary Jo O'Sullivan; Baha Sibai; Oded Langer; John M Thorp; Susan M Ramin; Brian M Mercer; Steven G Gabbe Journal: N Engl J Med Date: 2004-12-14 Impact factor: 91.245
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