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Obstet Gynecol. 2004 Feb;103(2):282-6.

Predicting failed trial of labor after primary cesarean delivery.

Author information

  • 1Department of Obstetrics and Gynecology, Medical College of Virginia Physicians and Hospitals of the Virginia Commonwealth University Health System, Richmond, Virginia, USA. mdinsmoor@enh.org

Abstract

OBJECTIVE:

To apply published scoring systems retrospectively to patients who had undergone a trial of labor after cesarean delivery to estimate whether there was a score at which a trial of labor should be discouraged.

METHODS:

Patients with 1 previous cesarean delivery who then delivered between January 1, 1998, and December 31, 1998, were studied. An investigator blinded to outcome assigned scores using 3 different scoring systems. Student t test, chi(2), analysis of variance, and receiver operating curve analysis were performed. P <.05 was significant.

RESULTS:

Seventy-six percent (117/153) of trial of labor patients had a vaginal birth after cesarean delivery. Successful vaginal birth after cesarean delivery patients had significantly different mean scores using all 3 scoring systems, but none of the systems accurately predicted failed trial of labor resulting in cesarean delivery. Unfavorable scores were associated with high rates of major complications.

CONCLUSIONS:

An unfavorable score predicting a high rate of complications and more failed trials of labor may help in counseling patients considering trial of labor. A better system to predict the success or failure of trial of labor is needed.

LEVEL OF EVIDENCE:

III

PMID:
14754696
[PubMed - indexed for MEDLINE]
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