Vaginal birth after cesarean success in high-risk women: A population-based study

Objective:The study aim was to identify factors associated with vaginal birth after cesarean (VBAC) in high-risk women.Study Design:This is a population-based retrospective cohort study of all births in Ohio during 2006 and 2007. High-risk patients were defined as singleton gestations in women with one previous cesarean who had ≥1 of the following risk factors: body mass index (BMI)≥30, hypertension, or diabetes. Multivariate logistic regression was utilized to estimate the relative influence of each factor on successful VBAC.Result:A total of 280 882 births were analyzed: of them, 79 084 (27.1%) were high-risk pregnancies and 8658 (10.9%) women had undergone one previous cesarean; 1433 (16.6%) underwent a trial of labor after cesarean (TOLAC). Of them, 974 (68.0%) had a successful VBAC, whereas 459 (32.0%) did not. Factors significantly associated with VBAC success were as follows: a prior vaginal delivery; pregnancy weight gain ≤30 lbs; Caucasian race; and labor augmentation.Conclusion:High-risk women with one prior cesarean are unlikely to undergo a TOLAC, but have a high rate of VBAC.