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Multicenter Study
. 2008 Feb;111(2 Pt 1):285-91.
doi: 10.1097/AOG.0b013e31816102b9.

Labor outcomes with increasing number of prior vaginal births after cesarean delivery

Brian M Mercer  1 , Sharon Gilbert, Mark B Landon, Catherine Y Spong, Kenneth J Leveno, Dwight J Rouse, Michael W Varner, Atef H Moawad, Hyagriv N Simhan, Margaret Harper, Ronald J Wapner, Yoram Sorokin, Menachem Miodovnik, Marshall Carpenter, Alan Peaceman, Mary J O'Sullivan, Baha M Sibai, Oded Langer, John M Thorp, Susan M Ramin; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network
Affiliations
Multicenter Study

Labor outcomes with increasing number of prior vaginal births after cesarean delivery

Brian M Mercer et al. Obstet Gynecol. 2008 Feb.

Abstract

Objective: To estimate the success rates and risks of an attempted vaginal birth after cesarean delivery (VBAC) according to the number of prior successful VBACs.

Methods: From a prospective multicenter registry collected at 19 clinical centers from 1999 to 2002, we selected women with one or more prior low transverse cesarean deliveries who attempted a VBAC in the current pregnancy. Outcomes were compared according to the number of prior VBAC attempts subsequent to the last cesarean delivery.

Results: Among 13,532 women meeting eligibility criteria, VBAC success increased with increasing number of prior VBACs: 63.3%, 87.6%, 90.9%, 90.6%, and 91.6% for those with 0, 1, 2, 3, and 4 or more prior VBACs, respectively (P<.001). The rate of uterine rupture decreased after the first successful VBAC and did not increase thereafter: 0.87%, 0.45%, 0.38%, 0.54%, 0.52% (P=.03). The risk of uterine dehiscence and other peripartum complications also declined statistically after the first successful VBAC. No increase in neonatal morbidities was seen with increasing VBAC number thereafter.

Conclusion: Women with prior successful VBAC attempts are at low risk for maternal and neonatal complications during subsequent VBAC attempts. An increasing number of prior VBACs is associated with a greater probability of VBAC success, as well as a lower risk of uterine rupture and perinatal complications in the current pregnancy.

Level of evidence: II.

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