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Am J Obstet Gynecol. 1992 Oct;167(4 Pt 1):1099-104.

Obstetric parameters affecting success in a trial of labor: designation of a scoring system.

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  • 1Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Science Center, Houston.



We sought to characterize risk factors in patients undergoing trial of labor after previous cesarean section and to determine whether a subset of patients at high risk of having an unsuccessful trial of labor consequently suffer greater morbidity.


A 13-month chart review analyzed 264 labors with documented transverse lower uterine segment scars. Historic and physical examination variables were recorded, and a scoring system was constructed to evaluate successful vaginal delivery after cesarean.


Successful vaginal delivery occurred in 192 patients, resulting in a rate of vaginal birth after cesarean of 72.7%. Four variables significantly lower the rate of vaginal birth after cesarean. Of patients scoring 0 (no variables present), 91.5% were successfully delivered vaginally. Scores of 1, 2, and 3 to 4 were associated with the success of vaginal birth after cesarean in 73.9%, 66.7%, and 46.1% of patients, respectively. A score of 3 to 4 did not increase maternal or fetal morbidity in trial-of-labor patients.


We constructed a scoring system to evaluate the success of vaginal birth after cesarean. Trial of labor in the subset of patients with the lowest success rate does not increase morbidity.

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