J Regan1, C Keup1, K Wolfe1, C Snyder1, E DeFranco2. 1. Division of Maternal-Fetal Medicine and Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH, USA. 2. 1] Division of Maternal-Fetal Medicine and Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH, USA [2] Center for Prevention of Preterm Birth, Perinatal Institute Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Abstract
OBJECTIVE: The study aim was to identify factors associated with vaginal birth after cesarean (VBAC) in high-risk women. STUDY DESIGN: This is a population-based retrospective cohort study of all births in Ohio during 2006 and 2007. High-risk patients were defined as singleton gestations in women with one previous cesarean who had ⩾1 of the following risk factors: body mass index (BMI)⩾30, hypertension, or diabetes. Multivariate logistic regression was utilized to estimate the relative influence of each factor on successful VBAC. RESULT: A total of 280 882 births were analyzed: of them, 79 084 (27.1%) were high-risk pregnancies and 8658 (10.9%) women had undergone one previous cesarean; 1433 (16.6%) underwent a trial of labor after cesarean (TOLAC). Of them, 974 (68.0%) had a successful VBAC, whereas 459 (32.0%) did not. Factors significantly associated with VBAC success were as follows: a prior vaginal delivery; pregnancy weight gain ⩽30 lbs; Caucasian race; and labor augmentation. CONCLUSION: High-risk women with one prior cesarean are unlikely to undergo a TOLAC, but have a high rate of VBAC.
OBJECTIVE: The study aim was to identify factors associated with vaginal birth after cesarean (VBAC) in high-risk women. STUDY DESIGN: This is a population-based retrospective cohort study of all births in Ohio during 2006 and 2007. High-risk patients were defined as singleton gestations in women with one previous cesarean who had ⩾1 of the following risk factors: body mass index (BMI)⩾30, hypertension, or diabetes. Multivariate logistic regression was utilized to estimate the relative influence of each factor on successful VBAC. RESULT: A total of 280 882 births were analyzed: of them, 79 084 (27.1%) were high-risk pregnancies and 8658 (10.9%) women had undergone one previous cesarean; 1433 (16.6%) underwent a trial of labor after cesarean (TOLAC). Of them, 974 (68.0%) had a successful VBAC, whereas 459 (32.0%) did not. Factors significantly associated with VBAC success were as follows: a prior vaginal delivery; pregnancy weight gain ⩽30 lbs; Caucasian race; and labor augmentation. CONCLUSION: High-risk women with one prior cesarean are unlikely to undergo a TOLAC, but have a high rate of VBAC.
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