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 journalArticle

217 Citations (Scopus)

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 languageEnglish
Pages (from-to)1016-1023
Number of pages8
JournalAmerican Journal of Obstetrics and Gynecology
Volume193
Issue number3 SUPPL.
DOIs
StatePublished - Sep 1 2005
Externally publishedYes

Fingerprint

Trial of Labor
Registries
Odds Ratio
Dystocia
Birth Weight
Mothers
Induced Labor
Observational Studies
Dilatation
Body Mass Index
Logistic Models
History
Regression Analysis
Parturition
Prospective Studies
Pregnancy

Keywords

  • Cesarean delivery
  • Dystocia
  • Trial of labor

ASJC Scopus subject areas

  • Medicine(all)
  • Obstetrics and Gynecology

Cite this

Landon, M. B., Leindecker, S., Spong, C. Y., Hauth, J. C., Bloom, S., Varner, M. W., ... 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

The MFMU Cesarean Registry : Factors affecting the success of trial of labor after previous cesarean delivery. / Landon, Mark B.; Leindecker, Sharon; Spong, Catherine Y.; Hauth, John C.; Bloom, Steven; Varner, Michael W.; Moawad, Atef H.; Caritis, Steve N.; Harper, Margaret; Wapner, Ronald J.; Sorokin, Yoram; Miodovnik, Menachem; Carpenter, Marshall; Peaceman, Alan M.; O'Sullivan, Mary Jo; Sibai, Baha M.; Langer, Oded; Thorp, John M.; Ramin, Susan M.; Mercer, Brian M.; Gabbe, Steven G.

In: American Journal of Obstetrics and Gynecology, Vol. 193, No. 3 SUPPL., 01.09.2005, p. 1016-1023.

Research output: Contribution to journalArticle

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
Landon, Mark B. ; Leindecker, Sharon ; Spong, Catherine Y. ; Hauth, John C. ; Bloom, Steven ; Varner, Michael W. ; Moawad, Atef H. ; Caritis, Steve N. ; Harper, Margaret ; Wapner, Ronald J. ; Sorokin, Yoram ; Miodovnik, Menachem ; Carpenter, Marshall ; Peaceman, Alan M. ; O'Sullivan, Mary Jo ; Sibai, Baha M. ; Langer, Oded ; Thorp, John M. ; Ramin, Susan M. ; Mercer, Brian M. ; Gabbe, Steven G. / The MFMU Cesarean Registry : Factors affecting the success of trial of labor after previous cesarean delivery. In: American Journal of Obstetrics and Gynecology. 2005 ; Vol. 193, No. 3 SUPPL. pp. 1016-1023.
@article{30780f5ec478493095ec77ef12e03993,
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.}",
year = "2005",
month = "9",
day = "1",
doi = "10.1016/j.ajog.2005.05.066",
language = "English",
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.

PY - 2005/9/1

Y1 - 2005/9/1

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

UR - http://www.scopus.com/inward/record.url?scp=24644507885&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=24644507885&partnerID=8YFLogxK

U2 - 10.1016/j.ajog.2005.05.066

DO - 10.1016/j.ajog.2005.05.066

M3 - Article

C2 - 16157104

AN - SCOPUS:24644507885

VL - 193

SP - 1016

EP - 1023

JO - American Journal of Obstetrics and Gynecology

JF - American Journal of Obstetrics and Gynecology

SN - 0002-9378

IS - 3 SUPPL.

ER -