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Induction of Labor After One Prior Cesarean: Predictors of Vaginal Delivery

From the Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois.

Address reprint requests to: William Grobman, MD, MBA, 333 East Superior Street, Suite 410, Chicago, IL 60611; e-mail: w-grobman{at}northwestern.edu.

OBJECTIVE: To estimate the characteristics most associated with vaginal birth in patients undergoing induction of labor after 1 prior cesarean delivery.

METHODS: All patients who presented for induction of labor from 1996 to 2001 with a history of 1 prior cesarean delivery were identified. Relevant demographic and obstetric data were abstracted from the charts. Univariate analysis was used to identify predictive factors associated with vaginal birth after cesarean. Binary logistic regression was further used to identify which factors were independently associated with the outcome measure.

RESULTS: Of the 429 women included in the study, 334 (77.9%) had a successful trial of labor. In the final binary logistic regression equation, prior vaginal delivery (odds ratio [OR] 3.75; 95% confidence interval [CI] 1.96, 7.18) remained independently associated with an increased chance of a vaginal delivery after a trial of labor. Conversely, prior cesarean delivery for dystocia (OR 0.46; 95% CI 0.27, 0.79), induction on or past the estimated date of delivery (OR 0.46; 95% CI 0.27, 0.78), need for cervical ripening (OR 0.35; 95% CI 0.20, 0.61), and maternal gestational or preexisting diabetes (OR 0.16; 95% CI 0.06, 0.40) were all factors associated with a decreased likelihood of achieving a successful trial of labor.

CONCLUSION: Several factors are available which may assist in identifying patients with the best chance of vaginal delivery after an induction of labor in the presence of a prior low-transverse cesarean scar.

LEVEL OF EVIDENCE: II-2