American Journal of Obstetrics & Gynecology
Volume 200, Issue 1 , Pages 56.e1-56.e6, January 2009

Can a prediction model for vaginal birth after cesarean also predict the probability of morbidity related to a trial of labor?

  • William A. Grobman, MD, MBA

      Affiliations

    • Department of Obstetrics and Gynecology at Northwestern University, Chicago, IL
    • ,
  • Yinglei Lai, PhD

      Affiliations

    • Department of Obstetrics and Gynecology at the George Washington University Biostatistics Center, Washington, DC
    • ,
  • Mark B. Landon, MD

      Affiliations

    • Department of Obstetrics and Gynecology at the Ohio State University, Columbus, OH
    • ,
  • Catherine Y. Spong, MD

      Affiliations

    • Department of Obstetrics and Gynecology at Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
    • ,
  • Kenneth J. Leveno, MD

      Affiliations

    • Department of Obstetrics and Gynecology at University of Texas Southwestern Medical Center, Dallas, TX
    • ,
  • Dwight J. Rouse, MD

      Affiliations

    • Department of Obstetrics and Gynecology at University of Alabama at Birmingham, Birmingham, AL
    • ,
  • Michael W. Varner, MD

      Affiliations

    • Department of Obstetrics and Gynecology at University of Utah, Salt Lake City, UT
    • ,
  • Atef H. Moawad, MD

      Affiliations

    • Department of Obstetrics and Gynecology at University of Chicago, Chicago, IL
    • ,
  • Steve N. Caritis, MD

      Affiliations

    • Department of Obstetrics and Gynecology at University of Pittsburgh, Pittsburgh, PA
    • ,
  • Margaret Harper, MD

      Affiliations

    • Department of Obstetrics and Gynecology at Wake Forest University, Winston-Salem, NC
    • ,
  • Ronald J. Wapner, MD

      Affiliations

    • Department of Obstetrics and Gynecology at Thomas Jefferson University, Philadelphia, PA
    • ,
  • Yoram Sorokin, MD

      Affiliations

    • Department of Obstetrics and Gynecology at Wayne State University, Detroit, MI
    • ,
  • Menachem Miodovnik, MD

      Affiliations

    • Department of Obstetrics and Gynecology at University of Cincinnati, Cincinnati, OH, and Columbia University, New York, NY
    • ,
  • Marshall Carpenter, MD

      Affiliations

    • Department of Obstetrics and Gynecology at Brown University, Providence, RI
    • ,
  • Mary J. O'Sullivan, MD

      Affiliations

    • Department of Obstetrics and Gynecology at University of Miami, Miami, FL
    • ,
  • Baha M. Sibai, MD

      Affiliations

    • Department of Obstetrics and Gynecology at University of Tennessee, Memphis, TN
    • ,
  • Oded Langer, MD

      Affiliations

    • Department of Obstetrics and Gynecology at University of Texas at San Antonio, San Antonio, TX
    • ,
  • John M. Thorp, MD

      Affiliations

    • Department of Obstetrics and Gynecology at University of North Carolina, Chapel Hill, NC
    • ,
  • Susan M. Ramin, MD

      Affiliations

    • Department of Obstetrics and Gynecology at University of Texas at Houston, Houston, TX
    • ,
  • Brian M. Mercer, MD

      Affiliations

    • Department of Obstetrics and Gynecology at Case Western Reserve University, Cleveland, OH
    • ,
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network

Received 20 February 2008; received in revised form 25 April 2008; accepted 12 June 2008. published online 26 September 2008.

Objective

The objective of the study was to determine whether a model for predicting vaginal birth after cesarean (VBAC) can also predict the probabilty of morbidity associated with a trial of labor (TOL).

Study Design

Using a previously published prediction model, we categorized women with 1 prior cesarean by chance of VBAC. Prevalence of maternal and neonatal morbidity was stratfied by probability of VBAC success and delivery approach.

Results

Morbidity became less frequent as the predicted chance of VBAC increased among women who underwent TOL (P < .001) but not elective repeat cesarean section (ERCS) (P > .05). When the predicted chance of VBAC was less than 70%, women undergoing a TOL were more likely to have maternal morbidity (relative risk [RR], 2.2; 95% confidence interval [CI], 1.5-3.1) than those who underwent an ERCS; when the predicted chance of VBAC was at least 70%, total maternal morbidity was not different between the 2 groups (RR, 0.8; 95% CI, 0.5-1.2). The results were similar for neonatal morbidity.

Conclusion

A prediction model for VBAC provides information regarding the chance of TOL-related morbidity and suggests that maternal morbidity is not greater for those women who undergo TOL than those who undergo ERCS if the chance of VBAC is at least 70%.

Key words: morbidity, prediction, vaginal birth after cesarean

To access this article, please choose from the options below

Login to an existing account or Register a new account.

  • Purchase this article for 30.00 USD (You must login/register to purchase this article)

    Online access for 24 hours. The PDF version can be downloaded as your permanent record.

  • Subscribe to this title

    Get unlimited online access to this article and all other articles in this title 24/7 for one year.

  • Claim access now

    For current subscribers with Society Membership or Account Number.

  • Visit SciVerse ScienceDirect to see if you have access via your institution.
 

 Cite this article as: Grobman WA, Lai Y, Landon MB, et al. Can a prediction model for vaginal birth after cesarean also predict the probability of morbidity related to a trial of labor? Am J Obstet Gynecol 2009;200:56.e1-56.e6.

 This study was 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).

 Reprints not available from the authors.

PII: S0002-9378(08)00660-1

doi:10.1016/j.ajog.2008.06.039

American Journal of Obstetrics & Gynecology
Volume 200, Issue 1 , Pages 56.e1-56.e6, January 2009

Article Tools