Trial of Labor After One Previous Cesarean Delivery for Multifetal Gestation

Varner, Michael W. MD1; Thom, Elizabeth PhD2; Spong, Catherine Y. MD3; Landon, Mark B. MD4; Leveno, Kenneth J. MD5; Rouse, Dwight J. MD6; Moawad, Atef H. MD7; Simhan, Hyagriv N. MD8; Harper, Margaret MD9; Wapner, Ronald J. MD10; Sorokin, Yoram MD11; Miodovnik, Menachem MD12,13; Carpenter, Marshall MD14; Peaceman, Alan MD15; O'Sullivan, Mary J. MD16; Sibai, Baha M. MD17; Langer, Oded MD18; Thorp, John M. MD19; Ramin, Susan M. MD20; Mercer, Brian M. MD21; for the National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units Network (MFMU)

Obstetrics & Gynecology:
doi: 10.1097/01.AOG.0000280586.05350.9e
Original Articles
Abstract

OBJECTIVE: To estimate success rates and risks with a trial of labor after one previous cesarean delivery for multifetal gestation compared with one previous cesarean delivery for a singleton pregnancy.

METHODS: Patients from the National Institute of Child Health and Human Development Maternal Fetal Medicine Units Network Cesarean Registry with one previous cesarean delivery and a current term singleton pregnancy were identified. Cases had one previous cesarean delivery for a multifetal pregnancy. Controls had one previous cesarean delivery for a singleton pregnancy.

RESULTS: Of cases, 556 of 944 (58.9%) attempted a trial of labor. Of controls, 13,923 of 29,329 (47.5%) attempted a trial of labor. The trial of labor success rate was 85.6% among cases and 73.1% among controls (odds ratio 2.19, 95% confidence interval 1.72–2.78). Compared with trial of labor controls, cases had no statistically increased risk of transfusion, endometritis, intensive care unit admissions, uterine rupture, or perinatal complications. Cases in this analysis with a successful trial of labor were more likely to have previously had a successful vaginal birth after cesarean (37.1% compared with 14.1%, P<.001).

CONCLUSION: Women with one previous cesarean delivery for a multifetal gestation have high trial of labor success rates and low complication rates.

LEVEL OF EVIDENCE: II

In Brief

Women with one previous cesarean delivery for a multifetal gestation have a high likelihood of a successful trial of labor with low complication rates.

Author Information

From the Departments of Obstetrics and Gynecology at 1University of Utah, Salt Lake City, Utah; 2George Washington University Biostatistics Center, Washington, DC; 3National Institute of Child Health and Human Development, Bethesda, Maryland; 4Ohio State University, Columbus, Ohio; 5University of Texas-Southwestern, Dallas, Texas; 6University of Alabama at Birmingham, Birmingham, Alabama; 7University of Chicago, Chicago, Illinois; 8University of Pittsburgh, Pittsburgh, Pennsylvania; 9Wake Forest University, Winston-Salem, North Carolina; 10Thomas Jefferson University, Philadelphia, Pennsylvania; 11Wayne State University, Detroit, Michigan; 12University of Cincinnati, Cincinnati, Ohio; 13Columbia University, New York, New York; 14Brown University, Providence, Rhode Island; 15Northwestern University, Chicago, Illinois; 16University of Miami, Miami, Florida; 17University of Tennessee, Memphis, Tennessee; 18University of Texas-San Antonio, San Antonio, Texas; 19University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; 20University of Texas-Houston, Houston, Texas; and 21Case Western Reserve University, Cleveland, Ohio.

* For members of the NICHD MFMU, see the Appendix.

Supported by the following grants from the National Institute of Child Health and Human Development: HD21410, HD21414, HD27860, HD27861, HD27869, HD27905, HD27915, HD27917, HD34116, HD34122, HD34136, HD34208, HD34210, HD40500, HD40485, HD40544, HD40545, HD40560, HD40512, and HD36801.

The authors thank Frances Johnson, RN, and Julia McCampbell, RN, for participating in protocol development and coordination between clinical research centers, and Sharon Gilbert, MS, for protocol and data management. Cora MacPherson, PhD, and Steven Weiner, MS, assisted with the statistical analysis.

Presented at the annual meeting of the Society for Maternal-Fetal Medicine, Miami, Florida, February 2–4, 2006.

Corresponding author: Michael W. Varner, MD, Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30 North 1900 East, Room 308, Salt Lake City, UT 84132; e-mail: mvarner@hsc.utah.edu.

Financial Disclosure The authors have no potential conflicts of interest to disclose.

© 2007 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.