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Vaginal Birth After Cesarean and Uterine Rupture Rates in California

From theDepartment of Obstetrics and Gynecology, Cedars Sinai Medical Center, Burns Allen Research Center, Los Angeles; Health Program of RAND, Santa Monica; and Departments of Medicine and Obstetrics and Gynecology, University of California, Los Angeles, School of Medicine, Los Angeles, California.

Address reprint requests to: Kimberly D. Gregory, MD, Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Suite 1740, Los Angeles, CA 90048, E-mail: gregory{at}cshs.org

Objective: To describe attempted and successful vaginal birth after cesarean (VBAC) rates and uterine rupture rates for women with and without prior cesareans, and compare delivery outcomes in hospitals with different attempted VBAC rates.

Methods: We used California hospital discharge summary data for 1995 to calculate attempted and successful VBAC rates and uterine rupture rates. We used multivariate logistic regression models to evaluate and adjust for age, ethnicity, and payment source. We report the relative risk (RR), attributable fraction, and 95% confidence intervals (CIs) for uterine rupture.

Results: There were 536,785 delivery discharges during 1995. The cesarean rate was 20.8%, and 12.5% of women had histories of cesareans. Of women with histories of cesareans, 61.4% attempted VBAC and 34.8% were successful. There were 392 uterine ruptures (0.07%). Women with prior cesareans were 16.98 (95% CI 13.51, 21.43) times more likely to experience uterine rupture, attributable fraction 66% (95% CI 60%, 73%). Among women with prior cesareans, those who attempted VBAC were 1.88 (95% CI 1.45, 2.44) times as likely to have uterine rupture, attributable fraction 34% (95% CI 21%, 46%). Women who delivered in hospitals with high attempted VBAC rates were less likely to have cesarean deliveries, more likely to have successful VBACs, and more likely to experience uterine ruptures.

Conclusion: Uterine rupture occurs at a low rate in women with and without prior cesarean delivery. Risk of rupture is increased among women with prior cesarean delivery and among those who attempt VBAC.

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