American Journal of Obstetrics & Gynecology
Volume 195, Issue 4 , Pages 1127-1131, October 2006

The MFMU Cesarean Registry: Impact of fetal size on trial of labor success for patients with previous cesarean for dystocia

  • Alan M. Peaceman, MD

      Affiliations

    • Department of Obstetrics and Gynecology at Northwestern University, Chicago, IL
    • ,
  • Rebecca Gersnoviez, MS

      Affiliations

    • The George Washington University Biostatistics Center, Washington, DC
    • ,
  • Mark B. Landon, MD

      Affiliations

    • The Ohio State University, Columbus, OH
    • ,
  • Catherine Y. Spong, MD

      Affiliations

    • National Institute of Child Health and Human Development, Bethesda, MD
    • ,
  • Kenneth J. Leveno, MD

      Affiliations

    • University of Texas Southwestern Medical Center, Dallas, TX
    • ,
  • Michael W. Varner, MD

      Affiliations

    • University of Utah, Salt Lake City, UT
    • ,
  • Dwight J. Rouse, MD, MSPH

      Affiliations

    • University of Alabama at Birmingham, Birmingham, AL
    • ,
  • Atef H. Moawad, MD

      Affiliations

    • University of Chicago, Chicago, IL
    • ,
  • Steve N. Caritis, MD

      Affiliations

    • University of Pittsburgh, Pittsburgh, PA
    • ,
  • Margaret Harper, MD

      Affiliations

    • Wake Forest University, Winston-Salem, NC
    • ,
  • Ronald J. Wapner, MD

      Affiliations

    • Thomas Jefferson University, Philadelphia, PA
    • ,
  • Yoram Sorokin, MD

      Affiliations

    • Wayne State University, Detroit, MI
    • ,
  • Menachem Miodovnik, MD

      Affiliations

    • University of Cincinnati, Cincinnati, OH
    • Columbia University, New York, NY
    • ,
  • Marshall Carpenter, MD

      Affiliations

    • Brown University, Providence, RI
    • ,
  • Mary J. O'Sullivan, MD

      Affiliations

    • University of Miami, Miami, FL
    • ,
  • Baha M. Sibai, MD

      Affiliations

    • University of Tennessee, Memphis, TN
    • ,
  • Oded Langer, MD

      Affiliations

    • University of Texas at San Antonio, San Antonio, TX
    • ,
  • John M. Thorp, MD

      Affiliations

    • University of North Carolina, Chapel Hill, NC
    • ,
  • Susan M. Ramin, MD

      Affiliations

    • University of Texas at Houston, Houston, TX
    • ,
  • Brian M. Mercer, MD

      Affiliations

    • Case Western Reserve University, Cleveland, OH
    • ,
  • for the National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network

Received 9 March 2006; received in revised form 16 May 2006; accepted 1 June 2006.

Objective

The purpose of this study was to determine the influence of change in infant birth weight between pregnancies on the outcome of a trial of labor for women whose first cesarean delivery was performed for dystocia.

Study design

Secondary analysis of 7081 patients with 1 previous cesarean delivery and no other deliveries after 20 weeks' gestation, undergoing a trial of labor with a singleton gestation. Cases were classified as dystocia if the listed indication for the cesarean delivery in the first pregnancy was failed induction, cephalo-pelvic disproportion, failure to progress, or failed forceps or vacuum. Outcomes of the trial of labor were correlated with fetal size relative to birth weight in the initial pregnancy for those women whose initial cesarean delivery was for dystocia and those with other indications.

Results

For the cohort being studied (n = 7081), dystocia was the indication for the first cesarean delivery for 3182 (44.9%). Trial of labor resulted in vaginal delivery for 54% of patients whose first cesarean delivery was performed for dystocia, compared with 67% for those with other indications (P < .01). For those whose first cesarean delivery was for dystocia, trial of labor success was correlated with birth weight differences between the pregnancies, with only 38% delivering vaginally if the trial of labor birth weight exceeded the initial pregnancy birth weight by more than 500 g. Using logistic regression and adjusting for other potential confounding factors, the odds of success decreased by 3.8% for each increase of 100 g in birth weight in the trial of labor relative to the first birth weight.

Conclusion

For women with previous cesarean delivery for dystocia, increasing birth weight in the subsequent trial of labor relative to the first birth weight diminishes the chances of successful vaginal delivery.

Key words: Cesarean delivery, Vaginal birth after cesarean, Dystocia, Birth weight

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 Supported by 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).Presented at the Twenty-Sixth Annual Meeting of the Society for Maternal Fetal Medicine, Miami, FL, January 30-February 4, 2006.Reprints not available from the authors.

PII: S0002-9378(06)00696-X

doi:10.1016/j.ajog.2006.06.003

American Journal of Obstetrics & Gynecology
Volume 195, Issue 4 , Pages 1127-1131, October 2006

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