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Trial of Labor after One Previous Cesarean Delivery for Multifetal Gestation

Citation

Varner, Michael W.; Thom, Elizabeth A.; Spong, Catherine Y.; Landon, Mark B.; Leveno, Kenneth J.; Rouse, Dwight J.; Moawad, Atef H.; Simhan, Hyagriv N.; Wapner, Ronald J.; & Sorokin, Yoram, et al. (2007). Trial of Labor after One Previous Cesarean Delivery for Multifetal Gestation. Obstetrics & Gynecology, 110(4), 814-819.

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.

URL

http://dx.doi.org/10.1097/01.AOG.0000280586.05350.9e

Reference Type

Journal Article

Year Published

2007

Journal Title

Obstetrics & Gynecology

Author(s)

Varner, Michael W.
Thom, Elizabeth A.
Spong, Catherine Y.
Landon, Mark B.
Leveno, Kenneth J.
Rouse, Dwight J.
Moawad, Atef H.
Simhan, Hyagriv N.
Wapner, Ronald J.
Sorokin, Yoram
Miodovnik, Menachem
Carpenter, Marshall W.
Peaceman, Alan M.
O'Sullivan, Mary Jo
Sibai, Baha M.
Langer, Oded
Thorp, John M., Jr.
Ramin, Susan M.
Mercer, Brian M., for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network