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Vaginal birth after cesarean: a 10-year experience. 1994

D A Miller, and F G Diaz, and R H Paul
Department of Obstetrics and Gynecology, University of Southern California, Los Angeles County.

OBJECTIVE To report the changing incidence of previous cesarean delivery, and the increasing use and success of a trial of labor and its effect on the repeat cesarean rate. METHODS Between 1983-1992, there were 164,815 deliveries at Los Angeles County+University of Southern California Women's Hospital, of which 17,322 (10.5%) were to women with at least one previous cesarean delivery. Data were gathered on an ongoing basis from delivery logs and patient charts. RESULTS Women with at least one previous cesarean accounted for 8.1% of all deliveries in 1983, increasing to 14.1% by 1992. Trial of labor was used in 80% of women with one previous cesarean, in 54% with two, and in 30% with three or more. The success rate was significantly higher with one previous cesarean (83%) than with two or more (75.3%). Furthermore, uterine rupture was three times more common with two or more previous cesareans. Compared to a policy of routine repeat cesarean, trial of labor yielded a 6.4% lower cesarean delivery rate. The majority of this benefit (5.5%) was derived by women with one previous cesarean. Among women undergoing a trial of labor, there were three rupture-related perinatal deaths and a single rupture-related maternal death. CONCLUSIONS Substantial reduction in the cesarean rate is achieved safely and efficiently by encouraging a trial of labor in women with a single previous cesarean delivery.

UI MeSH Term Description Entries
D007231 Infant, Newborn An infant during the first 28 days after birth. Neonate,Newborns,Infants, Newborn,Neonates,Newborn,Newborn Infant,Newborn Infants
D011247 Pregnancy The status during which female mammals carry their developing young (EMBRYOS or FETUSES) in utero before birth, beginning from FERTILIZATION to BIRTH. Gestation,Pregnancies
D011256 Pregnancy Outcome Results of conception and ensuing pregnancy, including LIVE BIRTH; STILLBIRTH; or SPONTANEOUS ABORTION. The outcome may follow natural or artificial insemination or any of the various ASSISTED REPRODUCTIVE TECHNIQUES, such as EMBRYO TRANSFER or FERTILIZATION IN VITRO. Outcome, Pregnancy,Outcomes, Pregnancy,Pregnancy Outcomes
D002585 Cesarean Section Extraction of the FETUS by means of abdominal HYSTEROTOMY. Abdominal Delivery,Delivery, Abdominal,C-Section (OB),Caesarean Section,Postcesarean Section,Abdominal Deliveries,C Section (OB),C-Sections (OB),Caesarean Sections,Cesarean Sections,Deliveries, Abdominal
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D012307 Risk Factors An aspect of personal behavior or lifestyle, environmental exposure, inborn or inherited characteristic, which, based on epidemiological evidence, is known to be associated with a health-related condition considered important to prevent. Health Correlates,Risk Factor Scores,Risk Scores,Social Risk Factors,Population at Risk,Populations at Risk,Correlates, Health,Factor, Risk,Factor, Social Risk,Factors, Social Risk,Risk Factor,Risk Factor Score,Risk Factor, Social,Risk Factors, Social,Risk Score,Score, Risk,Score, Risk Factor,Social Risk Factor
D013997 Time Factors Elements of limited time intervals, contributing to particular results or situations. Time Series,Factor, Time,Time Factor
D014219 Trial of Labor Allowing a woman to be in LABOR, OBSTETRIC long enough to determine if vaginal birth may be anticipated. Labor Trial,Labor Trials
D015994 Incidence The number of new cases of a given disease during a given period in a specified population. It also is used for the rate at which new events occur in a defined population. It is differentiated from PREVALENCE, which refers to all cases in the population at a given time. Attack Rate,Cumulative Incidence,Incidence Proportion,Incidence Rate,Person-time Rate,Secondary Attack Rate,Attack Rate, Secondary,Attack Rates,Cumulative Incidences,Incidence Proportions,Incidence Rates,Incidence, Cumulative,Incidences,Person time Rate,Person-time Rates,Proportion, Incidence,Rate, Attack,Rate, Incidence,Rate, Person-time,Rate, Secondary Attack,Secondary Attack Rates

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