Can a prediction model for vaginal birth after cesarean also predict the probability of morbidity related to a trial of labor? - 12/08/11

Doi : 10.1016/j.ajog.2008.06.039

William A. Grobman, MD, MBA ^a, Yinglei Lai, PhD ^s, Mark B. Landon, MD ^b, Catherine Y. Spong, MD ^t, Kenneth J. Leveno, MD ^c, Dwight J. Rouse, MD ^d, Michael W. Varner, MD ^e, Atef H. Moawad, MD ^f, Steve N. Caritis, MD ^g, Margaret Harper, MD ^h, Ronald J. Wapner, MD ⁱ, Yoram Sorokin, MD ^j, Menachem Miodovnik, MD ^k, Marshall Carpenter, MD ^l, Mary J. O'Sullivan, MD ^m, Baha M. Sibai, MD ⁿ, Oded Langer, MD ^o, John M. Thorp, MD ^p, Susan M. Ramin, MD ^q, Brian M. Mercer, MD ^r
Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network
^a Department of Obstetrics and Gynecology at Northwestern University, Chicago, IL
^b Department of Obstetrics and Gynecology at the Ohio State University, Columbus, OH
^c Department of Obstetrics and Gynecology at University of Texas Southwestern Medical Center, Dallas, TX
^d Department of Obstetrics and Gynecology at University of Alabama at Birmingham, Birmingham, AL
^e Department of Obstetrics and Gynecology at University of Utah, Salt Lake City, UT
^f Department of Obstetrics and Gynecology at University of Chicago, Chicago, IL
^g Department of Obstetrics and Gynecology at University of Pittsburgh, Pittsburgh, PA
^h Department of Obstetrics and Gynecology at Wake Forest University, Winston-Salem, NC
ⁱ Department of Obstetrics and Gynecology at Thomas Jefferson University, Philadelphia, PA
^j Department of Obstetrics and Gynecology at Wayne State University, Detroit, MI
^k Department of Obstetrics and Gynecology at University of Cincinnati, Cincinnati, OH, and Columbia University, New York, NY
^l Department of Obstetrics and Gynecology at Brown University, Providence, RI
^m Department of Obstetrics and Gynecology at University of Miami, Miami, FL
ⁿ Department of Obstetrics and Gynecology at University of Tennessee, Memphis, TN
^o Department of Obstetrics and Gynecology at University of Texas at San Antonio, San Antonio, TX
^p Department of Obstetrics and Gynecology at University of North Carolina, Chapel Hill, NC
^q Department of Obstetrics and Gynecology at University of Texas at Houston, Houston, TX
^r Department of Obstetrics and Gynecology at Case Western Reserve University, Cleveland, OH
^s Department of Obstetrics and Gynecology at the George Washington University Biostatistics Center, Washington, DC
^t Department of Obstetrics and Gynecology at Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD

Résumé

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%.

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Key words : morbidity, prediction, vaginal birth after cesarean

Plan

Materials and Methods

Results

Comment

	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.

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Vol 200 - N° 1

P. 56.e1-56.e6 - janvier 2009 Retour au numéro

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Can a prediction model for vaginal birth after cesarean also predict the probability of morbidity related to a trial of labor? - 12/08/11

Résumé

Objective

Study Design

Results

Conclusion

Plan

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