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White’s Classification of Maternal Diabetes and Vaginal Birth after Cesarean Delivery Success in Women Undergoing a Trial of Labor

Citation

Cormier, Clint M.; Landon, Mark B.; Lai, Yinglei; Spong, Catherine Y.; Rouse, Dwight J.; Leveno, Kenneth J.; Varner, Michael W.; Simhan, Hyagriv N.; Wapner, Ronald J.; & Sorokin, Yoram, et al. (2010). White's Classification of Maternal Diabetes and Vaginal Birth after Cesarean Delivery Success in Women Undergoing a Trial of Labor. Obstetrics & Gynecology, 115(1), 60-64. PMCID: PMC2844346

Abstract

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.

URL

http://dx.doi.org/10.1097/AOG.0b013e3181c534ca

Reference Type

Journal Article

Year Published

2010

Journal Title

Obstetrics & Gynecology

Author(s)

Cormier, Clint M.
Landon, Mark B.
Lai, Yinglei
Spong, Catherine Y.
Rouse, Dwight J.
Leveno, Kenneth J.
Varner, Michael W.
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.
Mercer, Brian M., for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network

PMCID

PMC2844346