Predicting failed trial of labor after primary cesarean delivery

Obstet Gynecol. 2004 Feb;103(2):282-6. doi: 10.1097/01.AOG.0000110544.42128.7a.


Objective: To apply published scoring systems retrospectively to patients who had undergone a trial of labor after cesarean delivery to estimate whether there was a score at which a trial of labor should be discouraged.

Methods: Patients with 1 previous cesarean delivery who then delivered between January 1, 1998, and December 31, 1998, were studied. An investigator blinded to outcome assigned scores using 3 different scoring systems. Student t test, chi(2), analysis of variance, and receiver operating curve analysis were performed. P <.05 was significant.

Results: Seventy-six percent (117/153) of trial of labor patients had a vaginal birth after cesarean delivery. Successful vaginal birth after cesarean delivery patients had significantly different mean scores using all 3 scoring systems, but none of the systems accurately predicted failed trial of labor resulting in cesarean delivery. Unfavorable scores were associated with high rates of major complications.

Conclusions: An unfavorable score predicting a high rate of complications and more failed trials of labor may help in counseling patients considering trial of labor. A better system to predict the success or failure of trial of labor is needed.

Level of evidence: III

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Analysis of Variance
  • Cesarean Section, Repeat / statistics & numerical data*
  • Female
  • Gestational Age
  • Humans
  • Incidence
  • Obstetric Labor Complications / epidemiology*
  • Predictive Value of Tests
  • Pregnancy
  • Pregnancy Outcome
  • Probability
  • Retrospective Studies
  • Risk Assessment
  • Sampling Studies
  • Sensitivity and Specificity
  • Trial of Labor*
  • Uterine Rupture / epidemiology
  • Uterine Rupture / etiology
  • Vaginal Birth after Cesarean