OBJECTIVE: To estimate the rate of vaginal birth after cesarean delivery (VBAC) success in diabetic women based on White’s Classification.
METHODS: This is a secondary analysis of an observational study conducted at 19 medical centers of women attempting VBAC. Diabetic women with singleton gestations, one prior cesarean delivery, and cephalic presentation who underwent a trial of labor were included. Vaginal birth after cesarean delivery success rates and maternal and neonatal complications were compared based on White’s Classification.
RESULTS: Of 11,856 women who underwent trial of labor, 624 met all study criteria (class A1, 356; A2, 169; B, 70; C, 21; D/R/F, 8). Vaginal birth after cesarean delivery success in each group was: A1, 68.5% (95% confidence interval [CI] 63.4–73.3%); A2, 55% (95% CI 47.2–62.7%); B, 70% (95% CI 57.9–80.4%); C, 47.6% (95% CI 25.7–70.2%); and D/F/R, 12.5% (95% CI 0.3–52.7%). Maternal and neonatal complications were rare and not found to be different among groups.
CONCLUSION: Our study provides estimates for VBAC success based on White’s classification and indicates a relatively low rate of perinatal complications after VBAC attempt for diabetic women.
LEVEL OF EVIDENCE: III
Our study provides estimates for vaginal birth after cesarean delivery (VBAC) success based on White’s Classification and indicates a relatively low rate of perinatal complications after VBAC attempt for diabetic women.
From the Departments of Obstetrics and Gynecology University of Texas Health Science Center at Houston, Houston, Texas; The Ohio State University, Columbus, Ohio; University of Alabama at Birmingham, Birmingham Alabama; University of Texas Southwestern Medical Center, Dallas, Texas; University of Utah, Salt Lake City, Utah; University of Pittsburgh, Pittsburgh, Pennsylvania; Thomas Jefferson University, Philadelphia, Pennsylvania; Wayne State University, Detroit, Michigan; University of Cincinnati, Cincinnati, Ohio; Columbia University, New York, New York; Brown University, Providence, Rhode Island; Northwestern University, Chicago, Illinois; University of Miami, Miami, Florida; University of Tennessee, Memphis, Tennessee; University of Texas Health Science Center at San Antonio, San Antonio, Texas; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Case Western Reserve University Cleveland, Ohio, The George Washington University Biostatistics Center, Washington, DC, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
*For a list of other members of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network, see the Appendix available online at http://links.lww.com/AOG/A137.
Supported by grants from the Eunice Kennedy Shriver 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).
Presented in part at the 55th Annual Meeting of the Society for Gynecologic Investigation, March 26–29, 2008, San Diego, California.
The authors thank Francee Johnson, RN, BSN, for protocol development and coordination between clinical research centers and Elizabeth Thom, PhD, and Sharon Gilbert, MS, MBA, for protocol and data management and statistical analysis.
Dr. Spong, Associate Editor of Obstetrics & Gynecology, was not involved in the review or decision to publish this article.
Corresponding author: Clint M. Cormier, MD, Department of Obstetrics, Gynecology, and Reproductive Services, University of Texas Health Sciences Center at Houston, 6431 Fannin Street, Suite 3.430, Houston, TX 77030; e-mail: firstname.lastname@example.org.
Financial Disclosure: The authors did not report any potential conflicts of interest.