Can a prediction model for vaginal birth after cesarean also predict the probability of morbidity related to a trial of labor?

William A. Grobman; Yinglei Lai; Mark B. Landon; Catherine Y. Spong; Kenneth J. Leveno; Dwight J. Rouse; Michael W. Varner; Atef H. Moawad; Steve N. Caritis; Margaret Harper; Ronald J. Wapner; Yoram Sorokin; Menachem Miodovnik; Marshall Carpenter; Mary J. O'Sullivan; Baha M. Sibai; Oded Langer; John M. Thorp; Susan M. Ramin; Brian M. Mercer

doi:10.1016/j.ajog.2008.06.039

Can a prediction model for vaginal birth after cesarean also predict the probability of morbidity related to a trial of labor?

William A. Grobman, Yinglei Lai, Mark B. Landon, Catherine Y. Spong, Kenneth J. Leveno, Dwight J. Rouse, Michael W. Varner, Atef H. Moawad, Steve N. Caritis, Margaret Harper, Ronald J. Wapner, Yoram Sorokin, Menachem Miodovnik, Marshall Carpenter, Mary J. O'Sullivan, Baha M. Sibai, Oded Langer, John M. Thorp, Susan M. Ramin, Brian M. Mercer

Research output: Contribution to journal › Article › peer-review

92 Scopus citations

Abstract

Objective: The objective of the study was to determine whether a model for predicting vaginal birth after cesarean (VBAC) can also predict the probabilty of morbidity associated with a trial of labor (TOL). Study Design: Using a previously published prediction model, we categorized women with 1 prior cesarean by chance of VBAC. Prevalence of maternal and neonatal morbidity was stratfied by probability of VBAC success and delivery approach. Results: Morbidity became less frequent as the predicted chance of VBAC increased among women who underwent TOL (P < .001) but not elective repeat cesarean section (ERCS) (P > .05). When the predicted chance of VBAC was less than 70%, women undergoing a TOL were more likely to have maternal morbidity (relative risk [RR], 2.2; 95% confidence interval [CI], 1.5-3.1) than those who underwent an ERCS; when the predicted chance of VBAC was at least 70%, total maternal morbidity was not different between the 2 groups (RR, 0.8; 95% CI, 0.5-1.2). The results were similar for neonatal morbidity. Conclusion: A prediction model for VBAC provides information regarding the chance of TOL-related morbidity and suggests that maternal morbidity is not greater for those women who undergo TOL than those who undergo ERCS if the chance of VBAC is at least 70%.

Original language	English (US)
Pages (from-to)	56.e1-56.e6
Journal	American journal of obstetrics and gynecology
Volume	200
Issue number	1
DOIs	https://doi.org/10.1016/j.ajog.2008.06.039
State	Published - Jan 2009

Keywords

morbidity
prediction
vaginal birth after cesarean

ASJC Scopus subject areas

Obstetrics and Gynecology

Access to Document

10.1016/j.ajog.2008.06.039

Cite this

Grobman, W. A., Lai, Y., Landon, M. B., Spong, C. Y., Leveno, K. J., Rouse, D. J., Varner, M. W., Moawad, A. H., Caritis, S. N., Harper, M., Wapner, R. J., Sorokin, Y., Miodovnik, M., Carpenter, M., O'Sullivan, M. J., Sibai, B. M., Langer, O., Thorp, J. M., Ramin, S. M., & Mercer, B. M. (2009). Can a prediction model for vaginal birth after cesarean also predict the probability of morbidity related to a trial of labor? American journal of obstetrics and gynecology, 200(1), 56.e1-56.e6. https://doi.org/10.1016/j.ajog.2008.06.039

Grobman, WA, Lai, Y, Landon, MB, Spong, CY, Leveno, KJ, Rouse, DJ, Varner, MW, Moawad, AH, Caritis, SN, Harper, M, Wapner, RJ, Sorokin, Y, Miodovnik, M, Carpenter, M, O'Sullivan, MJ, Sibai, BM, Langer, O, Thorp, JM, Ramin, SM & Mercer, BM 2009, 'Can a prediction model for vaginal birth after cesarean also predict the probability of morbidity related to a trial of labor?', American journal of obstetrics and gynecology, vol. 200, no. 1, pp. 56.e1-56.e6. https://doi.org/10.1016/j.ajog.2008.06.039

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title = "Can a prediction model for vaginal birth after cesarean also predict the probability of morbidity related to a trial of labor?",

abstract = "Objective: The objective of the study was to determine whether a model for predicting vaginal birth after cesarean (VBAC) can also predict the probabilty of morbidity associated with a trial of labor (TOL). Study Design: Using a previously published prediction model, we categorized women with 1 prior cesarean by chance of VBAC. Prevalence of maternal and neonatal morbidity was stratfied by probability of VBAC success and delivery approach. Results: Morbidity became less frequent as the predicted chance of VBAC increased among women who underwent TOL (P < .001) but not elective repeat cesarean section (ERCS) (P > .05). When the predicted chance of VBAC was less than 70%, women undergoing a TOL were more likely to have maternal morbidity (relative risk [RR], 2.2; 95% confidence interval [CI], 1.5-3.1) than those who underwent an ERCS; when the predicted chance of VBAC was at least 70%, total maternal morbidity was not different between the 2 groups (RR, 0.8; 95% CI, 0.5-1.2). The results were similar for neonatal morbidity. Conclusion: A prediction model for VBAC provides information regarding the chance of TOL-related morbidity and suggests that maternal morbidity is not greater for those women who undergo TOL than those who undergo ERCS if the chance of VBAC is at least 70%.",

keywords = "morbidity, prediction, vaginal birth after cesarean",

author = "Grobman, {William A.} and Yinglei Lai and Landon, {Mark B.} and Spong, {Catherine Y.} and Leveno, {Kenneth J.} and Rouse, {Dwight J.} and Varner, {Michael W.} and Moawad, {Atef H.} and Caritis, {Steve N.} and Margaret Harper and Wapner, {Ronald J.} and Yoram Sorokin and Menachem Miodovnik and Marshall Carpenter and O'Sullivan, {Mary J.} and Sibai, {Baha M.} and Oded Langer and Thorp, {John M.} and Ramin, {Susan M.} and Mercer, {Brian M.}",

year = "2009",

month = jan,

doi = "10.1016/j.ajog.2008.06.039",

language = "English (US)",

volume = "200",

pages = "56.e1--56.e6",

journal = "American journal of obstetrics and gynecology",

issn = "0002-9378",