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Review
. 2010 Jun;115(6):1267-1278.
doi: 10.1097/AOG.0b013e3181df925f.

Vaginal birth after cesarean: new insights on maternal and neonatal outcomes

Jeanne-Marie Guise  1 , Mary Anna Denman, Cathy Emeis, Nicole Marshall, Miranda Walker, Rongwei Fu, Rosalind Janik, Peggy Nygren, Karen B Eden, Marian McDonagh
Affiliations
Review

Vaginal birth after cesarean: new insights on maternal and neonatal outcomes

Jeanne-Marie Guise et al. Obstet Gynecol. 2010 Jun.

Abstract

Objective: To systematically review the evidence about maternal and neonatal outcomes relating to vaginal birth after cesarean (VBAC).

Data sources: Relevant studies were identified from multiple searches of MEDLINE, DARE, and the Cochrane databases (1980 to September 2009) and from recent systematic reviews, reference lists, reviews, editorials, Web sites, and experts.

Methods of study selection: Inclusion criteria limited studies to the English-language and human studies conducted in the United States and developed countries specifically evaluating birth after previous cesarean delivery. Studies focusing on high-risk maternal or neonatal conditions, including breech vaginal delivery, or fewer than 10 patients were excluded. Poor-quality studies were not included in analyses.

Tabulation, integration, and results: We identified 3,134 citations and reviewed 963 articles for inclusion; 203 articles met the inclusion criteria and were quality rated. Overall rates of maternal harms were low for both trial of labor and elective repeat cesarean delivery. Although rare in both elective repeat cesarean delivery and trial of labor, maternal mortality was significantly increased for elective repeat cesarean delivery at 0.013% compared with 0.004% for trial of labor. The rates of maternal hysterectomy, hemorrhage, and transfusions did not differ significantly between trial of labor and elective repeat cesarean delivery. The rate of uterine rupture for all women with prior cesarean was 0.30%, and the risk was significantly increased for trial of labor (0.47% compared with 0.03% for elective repeat cesarean delivery). Perinatal mortality was also significantly increased for trial of labor (0.13% compared with 0.05% for elective repeat cesarean delivery).

Conclusion: Overall the best evidence suggests that VBAC is a reasonable choice for the majority of women. Adverse outcomes were rare for both elective repeat cesarean delivery and trial of labor. Definitive studies are lacking to identify patients who are at greatest risk for adverse outcomes.

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References

    1. Hamilton BE, Martin JA, Ventura SJ. Births: Preliminary data for 2008. Natl Vital Stat Rep 2010;58(16):1–17.
    1. Placek PJ, Taffel S, Moien M. Cesarean section delivery rates: United States, 1981. Am J Public Health 1981;73:861–2.
    1. The world factbook. Washington, DC: Central Intelligence Agency; 2008.
    1. Guise JM, McDonagh MS, Hashima J, Kraemer DF, Eden KB, Berlin M, et al. Vaginal birth after cesarean (VBAC). Evid Rep Technol Assess (Summ) 2003:1–8.
    1. MacDorman MF, Kirmeyer S, MacDorman MF, Kirmeyer S. Fetal and perinatal mortality, United States, 2005. Natl Vital Stat Rep 2009;57:1–19.

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