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. 2009 Jan;200(1):56.e1-6.
doi: 10.1016/j.ajog.2008.06.039. Epub 2008 Sep 25.

Can a prediction model for vaginal birth after cesarean also predict the probability of morbidity related to a trial of labor?

William A Grobman  1 , Yinglei Lai, Mark B Landon, Catherine Y Spong, Kenneth J Leveno, Dwight J Rouse, Michael W Varner, Atef H Moawad, Steve N Caritis, Margaret Harper, Ronald J Wapner, Yoram Sorokin, Menachem Miodovnik, Marshall Carpenter, Mary J O'Sullivan, Baha M Sibai, Oded Langer, John M Thorp, Susan M Ramin, Brian M Mercer; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network
Collaborators, Affiliations

Can a prediction model for vaginal birth after cesarean also predict the probability of morbidity related to a trial of labor?

William A Grobman et al. Am J Obstet Gynecol. 2009 Jan.

Abstract

Objective: The objective of the study was to determine whether a model for predicting vaginal birth after cesarean (VBAC) can also predict the probabilty of morbidity associated with a trial of labor (TOL).

Study design: Using a previously published prediction model, we categorized women with 1 prior cesarean by chance of VBAC. Prevalence of maternal and neonatal morbidity was stratfied by probability of VBAC success and delivery approach.

Results: Morbidity became less frequent as the predicted chance of VBAC increased among women who underwent TOL (P < .001) but not elective repeat cesarean section (ERCS) (P > .05). When the predicted chance of VBAC was less than 70%, women undergoing a TOL were more likely to have maternal morbidity (relative risk [RR], 2.2; 95% confidence interval [CI], 1.5-3.1) than those who underwent an ERCS; when the predicted chance of VBAC was at least 70%, total maternal morbidity was not different between the 2 groups (RR, 0.8; 95% CI, 0.5-1.2). The results were similar for neonatal morbidity.

Conclusion: A prediction model for VBAC provides information regarding the chance of TOL-related morbidity and suggests that maternal morbidity is not greater for those women who undergo TOL than those who undergo ERCS if the chance of VBAC is at least 70%.

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