Format

Send to

Choose Destination
See comment in PubMed Commons below
Obstet Gynecol. 2008 Mar;111(3):654-8. doi: 10.1097/AOG.0b013e318163be22.

Racial disparity in the success and complications of vaginal birth after cesarean delivery.

Author information

  • 1Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri, USA. cahilla@wustl.edu

Abstract

OBJECTIVE:

To determine if race is associated with election to attempt vaginal birth after cesarean delivery (VBAC), VBAC success, and maternal morbidities associated with VBAC.

METHODS:

A retrospective, multi-center cohort study was conducted of women with a history of at least one prior cesarean delivery. Data were obtained on maternal demographics, medical history, antepartum and intrapartum course, delivery mode, and maternal outcomes. This analysis examines the association between race and the choice to have VBAC and compares the rates of VBAC success and maternal morbidity, including uterine rupture, and a composite morbidity outcome (uterine rupture, bladder and bowel injury, and artery laceration) across race groups. Race was determined by patient self-report. Univariable and multivariable analyses were performed to assess the independent association of race and clinical outcomes.

RESULTS:

The cohort included 25,005 patients with at least one prior cesarean delivery. In unadjusted and multivariable analysis, black patients were more likely to undertake a trial of labor than patients of other races, and slightly more likely to experience a failure of VBAC attempt. However, black women who attempt VBAC are 40% less likely to sustain a uterine rupture (0.6% compared with 1.1%) than other racial groups, even after adjusting for relevant potentially confounding variables.

CONCLUSION:

Despite increased rates of VBAC attempt and VBAC failure among black women as compared with other racial groups, black women are significantly less likely to experience a uterine rupture. It is unclear whether this discrepancy in magnitudes of risks and benefits across race associated with VBAC trials is attributable to selection bias or inherent racial differences.

[PubMed - indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Loading ...
    Write to the Help Desk