Vaginal birth after cesarean delivery: are there useful and valid predictors of success or failure?

Am J Obstet Gynecol. 1992 Jun;166(6 Pt 1):1811-5; discussion 1815-9. doi: 10.1016/0002-9378(92)91572-r.

Abstract

Objective: Before parturition are there useful and valid predictors of successful or unsuccessful vaginal birth after previous cesarean birth that could be used to enhance the obstetric care of a patient and her pregnancy?

Study design: The clinical course and outcome of all patients who attempted vaginal birth after cesarean delivery at one level III center during 1989 were evaluated to identify factors prognostic of a successful or unsuccessful patient group; use of this information in stepwise logistic regression and cluster analysis was disappointing.

Results: No single criterion or optimal clusters of factors were found and no equation achieved greater than 75% predictability of outcome with acceptable sensitivity and specificity.

Conclusions: Before parturition prediction of outcome of vaginal birth after cesarean delivery is tenuous regardless of past obstetric history or recent clinical parameters. Thus it seems appropriate to encourage a trial of labor in almost all patients with a prior low-segment uterine incision (transverse or vertical) unless there is a strong physician or patient-derived contraindication to such an undertaking.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Body Weight
  • Female
  • Fetus / anatomy & histology
  • Forecasting
  • Humans
  • Labor, Obstetric
  • Pregnancy
  • Regression Analysis
  • Vaginal Birth after Cesarean*