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

被引:289
作者
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
机构
[1] Ohio State Univ, Coll Med & Publ Hlth, Dept Obstet & Gynecol, Columbus, OH 43210 USA
[2] George Washington Univ, Ctr Biostat, Dept Obstet & Gynecol, Washington, DC USA
[3] NICHHD, Dept Obstet & Gynecol, Bethesda, MD 20892 USA
[4] Univ Alabama, Dept Obstet & Gynecol, Birmingham, AL 35294 USA
[5] Univ Texas, SW Med Ctr, Dept Obstet & Gynecol, Dallas, TX 75235 USA
[6] Univ Utah, Dept Obstet & Gynecol, Salt Lake City, UT USA
[7] Univ Chicago, Dept Obstet & Gynecol, Chicago, IL 60637 USA
[8] Univ Pittsburgh, Dept Obstet & Gynecol, Pittsburgh, PA USA
[9] Wake Forest Univ, Dept Obstet & Gynecol, Winston Salem, NC 27109 USA
[10] Thomas Jefferson Univ, Dept Obstet & Gynecol, Philadelphia, PA 19107 USA
[11] Wayne State Univ, Dept Obstet & Gynecol, Detroit, MI USA
[12] Univ Cincinnati, Dept Obstet & Gynecol, Cincinnati, OH USA
[13] Columbia Univ, Dept Obstet & Gynecol, New York, NY USA
[14] Brown Univ, Dept Obstet & Gynecol, Providence, RI 02912 USA
[15] Northwestern Univ, Dept Obstet & Gynecol, Chicago, IL 60611 USA
[16] Univ Miami, Dept Obstet & Gynecol, Miami, FL 33152 USA
[17] Univ Tennessee, Dept Obstet & Gynecol, Memphis, TN 38103 USA
[18] Univ Texas, Hlth Sci Ctr, Dept Obstet & Gynecol, San Antonio, TX 78284 USA
[19] Univ N Carolina, Dept Obstet & Gynecol, Chapel Hill, NC USA
[20] Univ Texas, Hlth Sci Ctr, Dept Obstet & Gynecol, Houston, TX USA
[21] Case Western Reserve Univ, Dept Obstet & Gynecol, Cleveland, OH 44106 USA
[22] Vanderbilt Univ, Dept Obstet & Gynecol, Nashville, TN USA
关键词
trial of labor; cesarean delivery; dystocia;
D O I
10.1016/j.ajog.2005.05.066
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
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% Cl 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% Cl 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. (C) 2005 Mosby, Inc. All rights reserved.
引用
收藏
页码:1016 / 1023
页数:8
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