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Effect of Prior Vaginal Delivery or Prior Vaginal Birth After Cesarean Delivery on Obstetric Outcomes in Women Undergoing Trial of Labor

Israel Hendler, MD^* and Emmanuel Bujold, MD^*

From the *Department of Obstetrics and Gynecology, Hutzel Hospital, Wayne State University, Detroit, Michigan; and Department of Obstetrics and Gynecology, Sainte-Justine Hospital, University of Montreal, Montreal, Quebec, Canada.

Address reprint requests to: Emmanuel Bujold, MD, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Hutzel Hospital, Wayne State University, 4707 St. Antoine Boulevard, Detroit, MI 48201; e-mail: ebujold{at}med.wayne.edu.

OBJECTIVE: We sought to study the effects of prior vaginal delivery or prior vaginal birth after cesarean delivery (VBAC) on the success of a trial of labor after a cesarean delivery.

METHODS: An observational study of patients who underwent a trial of labor after a single low-transverse cesarean delivery. Patients with a previous cesarean delivery and no vaginal birth were compared with patients with a single vaginal delivery before or after the previous cesarean delivery. The rates of successful VBAC, uterine rupture, and scar dehiscence were analyzed. Multivariable regression was performed to adjust for confounding variables.

RESULTS: Of 2,204 patients, 1,685 (76.4%) had a previous cesarean delivery and no vaginal delivery, 198 (9.0%) had a vaginal delivery before the cesarean delivery, and 321 (14.6%) had a prior VBAC. The rate of successful trial of labor was 70.1%, 81.8%, and 93.1%, respectively (P < .001). A prior VBAC was associated with fewer third- and fourth-degree lacerations (8.5% versus 2.5% versus 3.7%, P < .001) and fewer operative vaginal deliveries (14.7% versus 5.6% versus 1.9%, P < .001) but not with uterine rupture (1.5% versus 0.5% versus 0.3%, P = .12). Patients with a prior VBAC had, in addition, a higher rate of uterine scar dehiscence (21.8%) compared with patients with a previous cesarean delivery and no vaginal delivery (5.3%; P = .001).

CONCLUSION: A prior vaginal delivery and, particularly, a prior VBAC are associated with a higher rate of successful trial of labor compared with patients with no prior vaginal delivery. In addition, prior VBAC is associated with an increased rate of uterine scar dehiscence.

LEVEL OF EVIDENCE: II-2

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