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abstract & commentary
Synopsis: Women have an excellent chance for a successful vaginal birth after a prior cesarean delivery.
Source: Jongen VHWM, et al. Br J Obstet Gynaecol 1998;105:1079-1081.
To determine the likelihood of a vaginal birth after a prior cesarean delivery (VBAC) performed for delay in descent in the second stage of labor, Jongen and colleagues performed a retrospective follow-up study of primiparous women who delivered at a medical center in the Netherlands between 1986 and 1998. Women were not included in the study if they had a cesarean delivery early in the second stage or because of a non-reassuring fetal heart rate tracing. Of 132 women eligble for the study, 29 had a repeat cesarean delivery while 103 elected to have a trial of labor. Eighty-two (80%) were successful, while 21 (20%) required a second cesarean delivery. Forty-one of 55 women (75%) who had experienced a failed instrumental delivery during their prior labor had a successful VBAC. One uterine dehiscence occurred. No difference was noted in mean birth weight between those patients who had an elective cesarean delivery and those who underwent a trial of labor.
Jongen et al conclude that women who had an arrest of descent in the second stage of labor requiring a cesarean section for their first delivery, including women who had a failed instrumental vaginal delivery birth, have an excellent chance for a successful vaginal birth after a prior cesarean delivery.
This study from the Netherlands confirms several earlier reports, namely, that women who have required cesarean delivery for failure to progress after reaching full dilatation have a higher probability of a successful VBAC. Even women whose history included a prior failed instrumental birth delivery had a success rate of 75%. These findings are in conflict with those of Hoskins and colleagues who reported a 13% success rate in women who required a cesarean delivery at full dilatation.1 However, that group included only 32 women. Hoskins et al did note that women whose first cesarean delivery was performed at 5 cm or less had a successful VBAC rate of 67%, and those who were delivered by cesarean section at a dilatation of 6-9 cm had a 69% success rate. Jongen et al do not provide data on the difference in birth weight between babies delivered by cesarean section in the index pregnancy and those delivered after a successful VBAC. Women who have required a cesarean delivery after reaching full dilatation are often reluctant to undergo a trial of labor. Despite this fact, the study is very encouraging.
1. Hoskins IA, et al. Obstet Gynecol 1997;89:591-593.