Is vaginal birth after cesarean (VBAC) or elective repeat cesarean safer in women with a prior vaginal delivery?

Alison G. Cahill, David M. Stamilio, Anthony O. Odibo, Jeffrey F. Peipert, Sarah J. Ratcliffe, Erika J. Stevens, Mary D. Sammel, George A. Macones

Research output: Contribution to journalArticle

85 Scopus citations

Abstract

Objective: This study was undertaken to determine whether vaginal birth after cesarean (VBAC) or elective repeat cesarean delivery is safer overall for a woman with a prior vaginal delivery. Study design: This retrospective cohort study of pregnant women from 1996 to 2000 who had a prior cesarean delivery, was conducted in 17 centers. Trained nurses extracted historical and maternal outcome data on subjects by using standardized tools. This planned secondary analysis examined the subcohort that had also previously undergone a vaginal delivery, comparing those who underwent a VBAC trial with those who elected to have a repeat cesarean delivery. Outcomes included uterine rupture, bladder injury, fever, transfusion and a composite (uterine rupture, bladder injury, and artery laceration). We performed bivariate and multivariable analyses. Results: Of 6619 patients with a prior cesarean delivery who had also had a prior vaginal delivery, 5041 patients attempted a VBAC delivery and 1578 had an elective cesarean delivery. Although there was no significant difference in uterine rupture or bladder injury between the two groups, women who underwent a VBAC attempt were less likely to experience the composite adverse maternal outcome, have a fever, or require a transfusion. Conclusion: Among VBAC candidates who have had a prior vaginal delivery, those who attempt a VBAC trial have decreased risk for overall major maternal morbidities, as well as maternal fever and transfusion requirement compared with women who elect repeat cesarean delivery. Physicians should make this more favorable benefit-risk ratio explicit when counseling this patient subpopulation on a trial of labor.

Original languageEnglish
Pages (from-to)1143-1147
Number of pages5
JournalAmerican journal of obstetrics and gynecology
Volume195
Issue number4
DOIs
StatePublished - Oct 1 2006

Keywords

  • Maternal safety
  • Prior vaginal delivery
  • Vaginal birth after cesarean

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    Cahill, A. G., Stamilio, D. M., Odibo, A. O., Peipert, J. F., Ratcliffe, S. J., Stevens, E. J., Sammel, M. D., & Macones, G. A. (2006). Is vaginal birth after cesarean (VBAC) or elective repeat cesarean safer in women with a prior vaginal delivery? American journal of obstetrics and gynecology, 195(4), 1143-1147. https://doi.org/10.1016/j.ajog.2006.06.045