The MFMU Cesarean Registry: Factors affecting the success of trial of labor after previous cesarean delivery

Mark B. Landon; Sharon Leindecker; Catherine Y. Spong; John C. Hauth; Steven Bloom; 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 M. Sibai; Oded Langer; John M. Thorp; Susan M. Ramin; Brian M. Mercer; Steven G. Gabbe

doi:10.1016/j.ajog.2005.05.066

The MFMU Cesarean Registry: Factors affecting the success of trial of labor after previous cesarean delivery

Mark B. Landon, Sharon Leindecker, Catherine Y. Spong, John C. Hauth, Steven Bloom, 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 M. Sibai, Oded Langer, John M. Thorp, Susan M. Ramin, Brian M. MercerSteven G. Gabbe

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

320 Scopus citations

Abstract

Objective: The purpose of this study was to determine which factors influence the likelihood of successful trial of labor (TOL) after 1 previous cesarean delivery (CD). Study design: We performed a multicenter 4-year prospective observational study (1999-2002) of all women with previous CD undergoing TOL. Women with term singleton pregnancies with 1 previous low transverse CD or unknown incision were included for analysis. Results: Fourteen thousand five hundred twenty-nine women underwent TOL, with 10,690 (73.6%) achieving successful VBAC. Women with previous vaginal birth had an 86.6% success rate compared with 60.9% in women without such a history (odds ratio [OR] 4.2; 95% CI 3.8-4.5; P < .001). TOL success rates were affected by previous indication for CD, need for induction or augmentation, cervical dilation on admission, birth weight, race, and maternal body mass index. Multivariate logistic regression analysis identified as predictive of TOL success: previous vaginal delivery (OR 3.9; 95% CI 3.6-4.3), previous indication not being dystocia (CPD/FTP) (OR 1.7; 95% CI 1.5-1.8), spontaneous labor (OR 1.6; 95% CI 1.5-1.8), birth weight <4000 g (OR 2.0; 95% CI 1.8-2.3), and Caucasian race (OR 1.8, 95% CI 1.6-1.9) (all P < .001). The overall TOL success rate in obese women (BMI ≥30) was lower (68.4%) than in nonobese women (79.6%) (P < .001), and when combined with induction and lack of previous vaginal delivery, successful VBAC occurred in only 44.2% of cases. Conclusion: Previous vaginal delivery including previous VBAC is the greatest predictor for successful TOL. Previous indication as dystocia, need for labor induction, or a maternal BMI ≥30 significantly lowers success rates.

Original language	English (US)
Pages (from-to)	1016-1023
Number of pages	8
Journal	American journal of obstetrics and gynecology
Volume	193
Issue number	3 SUPPL.
DOIs	https://doi.org/10.1016/j.ajog.2005.05.066
State	Published - Sep 2005

Keywords

Cesarean delivery
Dystocia
Trial of labor

ASJC Scopus subject areas

Obstetrics and Gynecology

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10.1016/j.ajog.2005.05.066

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Landon, M. B., Leindecker, S., Spong, C. Y., Hauth, J. C., Bloom, S., Varner, M. W., Moawad, A. H., Caritis, S. N., Harper, M., Wapner, R. J., Sorokin, Y., Miodovnik, M., Carpenter, M., Peaceman, A. M., O'Sullivan, M. J., Sibai, B. M., Langer, O., Thorp, J. M., Ramin, S. M., ... Gabbe, S. G. (2005). The MFMU Cesarean Registry: Factors affecting the success of trial of labor after previous cesarean delivery. American journal of obstetrics and gynecology, 193(3 SUPPL.), 1016-1023. https://doi.org/10.1016/j.ajog.2005.05.066

Landon, MB, Leindecker, S, Spong, CY, Hauth, JC, Bloom, S, Varner, MW, Moawad, AH, Caritis, SN, Harper, M, Wapner, RJ, Sorokin, Y, Miodovnik, M, Carpenter, M, Peaceman, AM, O'Sullivan, MJ, Sibai, BM, Langer, O, Thorp, JM, Ramin, SM, Mercer, BM & Gabbe, SG 2005, 'The MFMU Cesarean Registry: Factors affecting the success of trial of labor after previous cesarean delivery', American journal of obstetrics and gynecology, vol. 193, no. 3 SUPPL., pp. 1016-1023. https://doi.org/10.1016/j.ajog.2005.05.066

@article{51b376318d794be28de1265ac5eeafae,

title = "The MFMU Cesarean Registry: Factors affecting the success of trial of labor after previous cesarean delivery",

abstract = "Objective: The purpose of this study was to determine which factors influence the likelihood of successful trial of labor (TOL) after 1 previous cesarean delivery (CD). Study design: We performed a multicenter 4-year prospective observational study (1999-2002) of all women with previous CD undergoing TOL. Women with term singleton pregnancies with 1 previous low transverse CD or unknown incision were included for analysis. Results: Fourteen thousand five hundred twenty-nine women underwent TOL, with 10,690 (73.6%) achieving successful VBAC. Women with previous vaginal birth had an 86.6% success rate compared with 60.9% in women without such a history (odds ratio [OR] 4.2; 95% CI 3.8-4.5; P < .001). TOL success rates were affected by previous indication for CD, need for induction or augmentation, cervical dilation on admission, birth weight, race, and maternal body mass index. Multivariate logistic regression analysis identified as predictive of TOL success: previous vaginal delivery (OR 3.9; 95% CI 3.6-4.3), previous indication not being dystocia (CPD/FTP) (OR 1.7; 95% CI 1.5-1.8), spontaneous labor (OR 1.6; 95% CI 1.5-1.8), birth weight <4000 g (OR 2.0; 95% CI 1.8-2.3), and Caucasian race (OR 1.8, 95% CI 1.6-1.9) (all P < .001). The overall TOL success rate in obese women (BMI ≥30) was lower (68.4%) than in nonobese women (79.6%) (P < .001), and when combined with induction and lack of previous vaginal delivery, successful VBAC occurred in only 44.2% of cases. Conclusion: Previous vaginal delivery including previous VBAC is the greatest predictor for successful TOL. Previous indication as dystocia, need for labor induction, or a maternal BMI ≥30 significantly lowers success rates.",

keywords = "Cesarean delivery, Dystocia, Trial of labor",

author = "Landon, {Mark B.} and Sharon Leindecker and Spong, {Catherine Y.} and Hauth, {John C.} and Steven Bloom 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 Peaceman, {Alan M.} and O'Sullivan, {Mary Jo} and Sibai, {Baha M.} and Oded Langer and Thorp, {John M.} and Ramin, {Susan M.} and Mercer, {Brian M.} and Gabbe, {Steven G.}",

note = "Funding Information: Supported by grants from the National Institute of Child Health and Human Development (HD21410, HD21414, HD27860, HD27861, HD27869, HD27883, HD27889, HD27905, HD27915, HD27917, HD34116, HD34122, HD34136, HD34208, HD34210, HD34136, HD40500, HD40485, HD40544, HD40545, HD40560, HD40512, HD19897, and HD36801). ",

year = "2005",

month = sep,

doi = "10.1016/j.ajog.2005.05.066",

language = "English (US)",

volume = "193",

pages = "1016--1023",

journal = "American journal of obstetrics and gynecology",

issn = "0002-9378",

publisher = "Mosby Inc.",

number = "3 SUPPL.",

}

TY - JOUR

T1 - The MFMU Cesarean Registry

T2 - Factors affecting the success of trial of labor after previous cesarean delivery

AU - Landon, Mark B.

AU - Leindecker, Sharon

AU - Spong, Catherine Y.

AU - Hauth, John C.

AU - Bloom, Steven

AU - Varner, Michael W.

AU - Moawad, Atef H.

AU - Caritis, Steve N.

AU - Harper, Margaret

AU - Wapner, Ronald J.

AU - Sorokin, Yoram

AU - Miodovnik, Menachem

AU - Carpenter, Marshall

AU - Peaceman, Alan M.

AU - O'Sullivan, Mary Jo

AU - Sibai, Baha M.

AU - Langer, Oded

AU - Thorp, John M.

AU - Ramin, Susan M.

AU - Mercer, Brian M.

AU - Gabbe, Steven G.

N1 - Funding Information: Supported by grants from the National Institute of Child Health and Human Development (HD21410, HD21414, HD27860, HD27861, HD27869, HD27883, HD27889, HD27905, HD27915, HD27917, HD34116, HD34122, HD34136, HD34208, HD34210, HD34136, HD40500, HD40485, HD40544, HD40545, HD40560, HD40512, HD19897, and HD36801).

PY - 2005/9

Y1 - 2005/9

N2 - Objective: The purpose of this study was to determine which factors influence the likelihood of successful trial of labor (TOL) after 1 previous cesarean delivery (CD). Study design: We performed a multicenter 4-year prospective observational study (1999-2002) of all women with previous CD undergoing TOL. Women with term singleton pregnancies with 1 previous low transverse CD or unknown incision were included for analysis. Results: Fourteen thousand five hundred twenty-nine women underwent TOL, with 10,690 (73.6%) achieving successful VBAC. Women with previous vaginal birth had an 86.6% success rate compared with 60.9% in women without such a history (odds ratio [OR] 4.2; 95% CI 3.8-4.5; P < .001). TOL success rates were affected by previous indication for CD, need for induction or augmentation, cervical dilation on admission, birth weight, race, and maternal body mass index. Multivariate logistic regression analysis identified as predictive of TOL success: previous vaginal delivery (OR 3.9; 95% CI 3.6-4.3), previous indication not being dystocia (CPD/FTP) (OR 1.7; 95% CI 1.5-1.8), spontaneous labor (OR 1.6; 95% CI 1.5-1.8), birth weight <4000 g (OR 2.0; 95% CI 1.8-2.3), and Caucasian race (OR 1.8, 95% CI 1.6-1.9) (all P < .001). The overall TOL success rate in obese women (BMI ≥30) was lower (68.4%) than in nonobese women (79.6%) (P < .001), and when combined with induction and lack of previous vaginal delivery, successful VBAC occurred in only 44.2% of cases. Conclusion: Previous vaginal delivery including previous VBAC is the greatest predictor for successful TOL. Previous indication as dystocia, need for labor induction, or a maternal BMI ≥30 significantly lowers success rates.

AB - Objective: The purpose of this study was to determine which factors influence the likelihood of successful trial of labor (TOL) after 1 previous cesarean delivery (CD). Study design: We performed a multicenter 4-year prospective observational study (1999-2002) of all women with previous CD undergoing TOL. Women with term singleton pregnancies with 1 previous low transverse CD or unknown incision were included for analysis. Results: Fourteen thousand five hundred twenty-nine women underwent TOL, with 10,690 (73.6%) achieving successful VBAC. Women with previous vaginal birth had an 86.6% success rate compared with 60.9% in women without such a history (odds ratio [OR] 4.2; 95% CI 3.8-4.5; P < .001). TOL success rates were affected by previous indication for CD, need for induction or augmentation, cervical dilation on admission, birth weight, race, and maternal body mass index. Multivariate logistic regression analysis identified as predictive of TOL success: previous vaginal delivery (OR 3.9; 95% CI 3.6-4.3), previous indication not being dystocia (CPD/FTP) (OR 1.7; 95% CI 1.5-1.8), spontaneous labor (OR 1.6; 95% CI 1.5-1.8), birth weight <4000 g (OR 2.0; 95% CI 1.8-2.3), and Caucasian race (OR 1.8, 95% CI 1.6-1.9) (all P < .001). The overall TOL success rate in obese women (BMI ≥30) was lower (68.4%) than in nonobese women (79.6%) (P < .001), and when combined with induction and lack of previous vaginal delivery, successful VBAC occurred in only 44.2% of cases. Conclusion: Previous vaginal delivery including previous VBAC is the greatest predictor for successful TOL. Previous indication as dystocia, need for labor induction, or a maternal BMI ≥30 significantly lowers success rates.

KW - Cesarean delivery

KW - Dystocia

KW - Trial of labor

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ER -

The MFMU Cesarean Registry: Factors affecting the success of trial of labor after previous cesarean delivery

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