Document Detail


The effect of prematurity on vaginal birth after cesarean delivery: success and maternal morbidity.
MedLine Citation:
PMID:  15738018     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: We sought to compare vaginal birth after cesarean (VBAC) success and uterine rupture rates between preterm and term gestations in women with a history of one prior cesarean delivery. Our hypothesis was that preterm women undergoing VBAC were more likely to be successful and have a lower rate of complications than term women undergoing VBAC. METHODS: We reviewed medical records of women with a history of a cesarean delivery who either attempted a VBAC or underwent a repeat cesarean delivery from 1995 through 2000 in 17 community and university hospitals. We collected information on demographics, medical and obstetric history, complications, and outcome of the index pregnancy. The primary analysis was limited to women with singleton gestations and one prior cesarean delivery. Statistical analysis consisted of bivariate and multivariable techniques. RESULTS: Among the 20,156 patients with one prior cesarean delivery, 12,463 (61%) attempted a VBAC. Mean gestational ages for the term and preterm women were 39.2 weeks and 33.9 weeks of gestation, respectively. The VBAC success rates for the term and preterm groups were 74% and 82%, respectively (P < .001). Multivariable analysis showed that the VBAC success was higher (adjusted odds ratio 1.54, 95% confidence interval 1.27-1.86) in preterm gestations. A decreased risk of rupture among preterm gestations was suggested in these results (adjusted odds ratio 0.28, 95% confidence interval 0.07-1.17; P = .08). CONCLUSION: Preterm patients undergoing a VBAC have higher success rates when compared with term patients undergoing a VBAC. Preterm patients undergoing VBAC may have lower uterine rupture rates.
Authors:
Joanne N Quiñones; David M Stamilio; Emmanuelle Paré; Jeffrey F Peipert; Erika Stevens; George A Macones
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Obstetrics and gynecology     Volume:  105     ISSN:  0029-7844     ISO Abbreviation:  Obstet Gynecol     Publication Date:  2005 Mar 
Date Detail:
Created Date:  2005-03-01     Completed Date:  2005-04-07     Revised Date:  2009-10-26    
Medline Journal Info:
Nlm Unique ID:  0401101     Medline TA:  Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  519-24     Citation Subset:  AIM; IM    
Affiliation:
Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, University of Pennsylvania Health System, Philadelphia, Pennsylvania 19104, USA. jquinones@mail.obgyn.upenn.edu
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MeSH Terms
Descriptor/Qualifier:
Cesarean Section, Repeat / adverse effects
Female
Gestational Age
Humans
Obstetric Labor, Premature*
Pregnancy
Pregnancy Complications
Risk Factors
Uterine Rupture / etiology
Vaginal Birth after Cesarean* / adverse effects
Grant Support
ID/Acronym/Agency:
K24 HD 01289/HD/NICHD NIH HHS; K24 HD 01298/HD/NICHD NIH HHS; R01 H035631//PHS HHS; T32 HD 07440-07/HD/NICHD NIH HHS

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