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Safety and Efficacy of Vaginal Birth After Cesarean Attempts at or Beyond 40 Weeks of Gestation

Coassolo, Kara M. MD; Stamilio, David M. MD, MSCE; Paré, Emmanuelle MD; Peipert, Jeffrey F. MD, MPH; Stevens, Erika MA; Nelson, Deborah B. PhD; Macones, George A. MD, MSCE

doi: 10.1097/01.AOG.0000179389.82986.50
Original Research

OBJECTIVE: To compare rates of vaginal birth after cesarean (VBAC) failure and major complications in women attempting VBAC before and after the estimated date of delivery (EDD)

METHODS: This was a 5-year retrospective cohort study in 17 university and community hospitals of women with at least 1 prior cesarean delivery. Women who attempted VBAC before the EDD were compared with those at or beyond 40 weeks of gestation. Logistic regression analyses were performed to assess the relationship between delivery beyond the EDD and VBAC failure or complication rate.

RESULTS: A total of 11,587 women in the cohort attempted VBAC. Women past 40 weeks of gestation were more likely to have a failed VBAC. After controlling for confounders, the increased risk of a failed VBAC beyond 40 weeks remained significant (31.3% compared with 22.2%, odds ratio 1.36, 95% confidence interval 1.24–1.50). The risk of uterine rupture (1.1% compared with 1.0%) or overall morbidity (2.7% compared with 2.1%) was not significantly increased in the women attempting VBAC beyond the EDD. When the cohort was defined as 41 weeks or more of gestation, the risk of a failed VBAC was again significantly increased (35.4% compared with 24.3%, odds ratio 1.35, 95% confidence interval 1.20–1.53), but the risk of uterine rupture or overall morbidity was not increased.

CONCLUSION: Women beyond 40 weeks of gestation can safely attempt VBAC, although the risk of VBAC failure is increased.

LEVEL OF EVIDENCE: II-2

Women beyond 40 weeks of gestation can safely attempt a vaginal birth after cesarean delivery; however, the risk of a failed trial of labor is increased.

From the 1Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; 2Department of Obstetrics and Gynecology, Womens’ and Infants’ Hospital, Providence, Rhode Island; and 3Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania.

Supported by a grant from NICHD (RO1 HD 35631; to Dr. Macones). Dr. Macones and Dr. Peipert are recipients of a K24 grant from NICHD (K24 HD01289), which partially supports this work.

Presented at the 53rd Annual Clinical Meeting of the American College of Obstetricians and Gynecologists; May 7-11, 2005, San Francisco, California.

Corresponding author: Kara M. Coassolo, MD, Hospital of the University of Pennsylvania, 3400 Spruce Street, 2000 Courtyard Building, Philadelphia, PA 19104; e-mail: kcoassolo@obgyn.upenn.edu.

© 2005 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.