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In Poland, as in other high-income countries, the rate of caesarean sections (CS) is alarmingly high. Promoting vaginal birth after caesarean section (VBAC) is one of the ways that may help to decrease CS rate. Despite the recommendations by the Polish Association of Gynaecologists and Obstetricians that one previous CS should not be an indication for a subsequent one and VBAC should be promoted, the rate of VBAC in Poland remains low. Research shows that in countries with high VBAC rates women felt supported by healthcare personnel to have VBAC. This study aims to explore the elements of Polish maternity services that contribute to or hinder women's chances of having a VBAC. The study used qualitative methods of research based on semi-structured interviews. We interviewed 22 women. Each woman was interviewed twice, once during pregnancy and then between 6 and 12 weeks after she had given birth. Women who planned vaginal birth after one previous CS engaged in various strategies such as seeking supportive personnel, opting for fee-for-service dedicated midwifery care or traveled long distances to give birth in facilities supporting VBAC. Polish maternity services do not support women on the way to vaginal birth after surgery. Access to VBAC in Poland is highly unequal and dependent on women's social and financial resources such as access to private care, place of residence, or social relationships. Efforts should be made to make access to VBAC more universal. [ABSTRACT FROM AUTHOR]

Women seeking a vaginal birth after a caesarean section (VBAC) frequently want to keep their subsequent labour and birth free from intervention. Water immersion (WI) during labour is potentially an effective tool for women having a VBAC for its natural pain-relieving properties. However, negotiating access to WI can be difficult, especially in the context of VBAC. To explore women's experiences of negotiating WI for labour and birth in the context of VBAC. This Grounded Theory study followed Strauss and Corbin's framework and analytic process. Twenty-five women planning or using WI for their VBAC labour or birth were recruited from two midwifery practices and a social media group across Australia. Participants were interviewed during pregnancy and/or postnatally. 'Taking the reins', the core category explaining the women's experiences of assuming authority over their birth, comprised five categories: 'Robbed of my previous birth experience'; 'My eyes were opened'; 'Water is my tool for a successful VBAC'; 'Actioning my choices and rights for WI', and 'Empowered to take back control'. 'Wanting natural and normal' was the driving force behind women's desire to birth vaginally. Two mediating factors: Having someone in your corner and Rules for birth facilitated or hindered their birth choices, respectively. The women became active participants in their healthcare by seeking information and options to keep their birth experience natural and normal. Support from other women and advocacy in the form of continuity of midwifery care was crucial in successfully negotiating WI for their VBAC when navigating the complex health system. [ABSTRACT FROM AUTHOR]

• A vaginal birth after caesarean (VBAC) is associated with fewer complications for both mother and baby compared to a repeat caesarean. • Little is known on the safety and success of planning a VBAC in midwifery led settings such as birth centres and home birth, compared to obstetric led settings. • Findings of this review show that planning VBAC in midwifery led settings is associated with increased vaginal birth and a reduction in interventions such as instrumental birth and caesarean section. Adverse perinatal outcomes are rare, and further research is required to draw conclusions on these risks. • This research will contribute to the limited knowledge base available to midwives, obstetricians and women planning vaginal birth after Caesarean (VBAC), enabling them to make more informed choices regarding planned place of birth. There is a limited knowledge base available to midwives, obstetricians and women planning vaginal birth after caesarean (VBAC), impeding their ability to make informed choices regarding planned place of birth. A VBAC is associated with fewer complications for both mother and baby, but little is known on the safety and success of planning a VBAC in midwifery led settings such as birth centres and home birth, compared to obstetric led settings. To synthesise the findings of published studies regarding maternal and neonatal outcomes with planned VBAC in midwifery setting compared to obstetric units. PubMed, EMBASE, CINAHL complete, Maternity and Infant Care, PsycINFO, and Science Citation Index databases were systematically searched on 16/08/2022 for all quantitative research on the outcomes for women planning VBAC in midwifery led settings compared to obstetric led settings in high income countries. Included studies were quality assessed using the CASP Checklist. Binary outcomes are incorporated into pairwise meta-analyses, effect sizes reported as risk ratios with 95 % confidence intervals. A τ² estimate of between-study variance was performed for each binary outcome analysis. Other, more heterogeneous outcomes are narratively reported. Two high-quality studies, out of 420 articles, were included. VBAC planned in a midwifery-led setting was associated with a statistically significant increase in unassisted vaginal birth (RR=1.42 95 % CI 1.37 to 1.48) and decrease in emergency caesarean section (RR= 0.46 95 % CI 0.39 to 0.56) and instrumental birth (RR= 0.33 95 % CI 0.23 to 0.47) compared with planned VBAC in an obstetric setting. There were no significant differences in uterine rupture (RR= 1.03 95 % CI 0.52 to 2.07), admission to special care nursery (RR= 0.71 95 % CI 0.47 to 1.23) or Apgar score of 7 or less at 5 min (RR= 1.16 95 % CI 0.66 to 2.03). Planning VBAC in midwifery led settings is associated with increased vaginal birth and a reduction in interventions such as instrumental birth and caesarean section. Adverse perinatal outcomes are rare, and further research is required to draw conclusions on these risks. [ABSTRACT FROM AUTHOR]

Women are offered the choice of vaginal birth or elective repeat caesarean section as although the absolute risks of major morbidity or mortality are lower with elective repeat caesarean in the short term, the risks of multiple caesareans such as invasive placental disorders and intra-abdominal adhesion formation, increase with the number of caesareans performed. Guiding patients in the clinic through this decision making process can be challenging but the use of a checklist can be of help. The most pertinent risk of vaginal birth after caesarean section is uterine rupture as it can give little warning to the clinician and can be catastrophic to mother and baby. Therefore, appropriate selection of patients and managing women labouring with a uterine scar is of utmost importance. [ABSTRACT FROM AUTHOR]

Birth positions may influence the risk of tears in the genital tract during birth. Birth positions are widely studied yet knowledge on genital tract tears following birth on a birth seat is inconclusive. The objective of this study was to describe the proportion of genital tract tears in women who gave birth on a birth seat compared to women who did not. An observational cohort study based on birth information collected prospectively. In total 10 629 live, singleton, non-instrumental births in cephalic presentation were studied. Fewer women who gave birth on a birth seat experienced an overall intact genital tract compared to women who gave birth in any other position. Women who gave birth on a birth seat were less likely to have an episiotomy performed. Women who gave birth vaginally on a birth seat after a previous caesarean section may have an increased risk for sustaining a sphincter tear. It is important to be aware of the decreased chance of an overall intact genital tract area when giving birth on a birth seat. Furthermore, there is a possibly increased risk of sphincter tear in women having a vaginal birth after caesarean. It is required and of importance to provide pregnant women with evidence-based information on factors associated with genital tract tears including birth positions. [ABSTRACT FROM AUTHOR]

Knowledge about labour characteristics of women achieving successful vaginal birth after caesarean section (VBAC) might be used to improve labour and birth management. This study examined sociodemographic and labour process-related factors regarding a) differences between countries, b) the comparison of successful VBAC with unplanned caesarean section, and c) predictors for the success of planned VBAC in three European countries. We analysed observational data collected within the OptiBIRTH trial, a cluster-randomised controlled trial. Fifteen study sites in Ireland, Italy and Germany, five in each country. 790 participants going into labour for planned VBAC. Descriptive statistics and random-effects logistic regression models were applied. The pooled successful VBAC-rate was 74.6%. Italy had the highest proportion of women receiving none of the four intrapartum interventions amniotomy (ARM), oxytocin, epidural or opioids (42.5% vs Ireland: 26.8% and Germany: 25.3%, p < 0.001). Earlier performance of ARM was associated with successful VBAC (3.50 hrs vs 6.08 hrs, p = 0.004). A positive predictor for successful vaginal birth was a previous vaginal birth (OR=3.73, 95% CI [2.17, 6.44], p < 0.001). The effect of ARM increased with longer labour duration (OR for interaction term=1.06, 95% CI [1.004, 1.12], p = 0.035). Higher infant birthweight (OR per kg=0.34, 95% CI [0.23, 0.50], p < 0.001), ARM (reference spontaneous rupture of membranes (SROM), OR=0.20, 95% CI [0.11, 0.37], p < 0.001) and a longer labour duration (OR per hour=0.93, 95% CI [0.90, 0.97], p < 0.001) decreased the odds of a vaginal birth. Women with a previous vaginal birth, an infant with a lower birth weight, SROM and a shorter labour duration were most likely to have a successful vaginal birth. If SROM did not occur, an earlier ARM increased the odds of a vaginal birth. Labour progress should be accelerated by fostering endogenous uterine contractions. With slow labour progress and intact membranes, ARM might increase the chance of a vaginal birth. [ABSTRACT FROM AUTHOR]

Caesarean section (CS) rates continue to evoke worldwide concern because of their steady increase. The national caesarean section (CS) rate in the UK is almost 25%, having increased by 5.7% in the last 10 years. A rising primary CS rate is a significant contributor to this trend. The latest available data show that almost 1 in 5 women in the world now give birth by CS. The World Health Organisation states that, when medically justified, a caesarean section can effectively prevent maternal and perinatal mortality and morbidity. However, there is no evidence showing the benefits of caesarean delivery for women or infants who do not require the procedure. As with any surgery, caesarean sections are associated with short and long-term risk which can extend many years beyond the current delivery and affect the health of the woman, her child, and future pregnancies. These risks are higher in women with limited access to comprehensive obstetric care. There are two standard care pathways for women having childbirth following previous CS – Vaginal Birth After Caesarean (VBAC) or Elective Repeat CS (ERCS). Attempting a VBAC is a safe and appropriate choice that must be offered to most women who have had a prior caesarean delivery. Approximately 70–75% of women who attempt VBAC will have a successful vaginal delivery. Focused antenatal counselling sessions highlighting the risks and benefits of VBAC vs ERCS may impact upon the pathway a woman chooses. Continued counselling and discussion of relative risks versus benefits will also encourage patient choice and help support the woman throughout antenatal and intrapartum periods. [ABSTRACT FROM AUTHOR]

The cesarean delivery rate in the United States has risen steadily over the past 5 decades such that approximately one in three women now undergo cesarean section. The rise in repeat operations and accompanying decline in trial of labor after cesarean (TOLAC) have been major contributors to this phenomenon. The appropriate use of TOLAC continues to be a topic of interest with the recognition that most women with a history of prior cesarean are candidates for trial of labor. The NICHD MFMU Network Cesarean Registry conducted from 1999 to 2002 provided contemporary data concerning the risks and benefits of TOLAC, which in turn have helped inform practitioners and women considering their options for childbirth following cesarean delivery. [ABSTRACT FROM AUTHOR]

Caesarean section (CS) has evolved from a procedure with considerable morbidity and mortality risks into one that is safe enough to be considered as a matter of maternal choice in high resource countries. Improvements in operative techniques, anaesthesia, intensive care, blood transfusion services and availability of antibiotics have all contributed to improved safety of the procedure for pregnant women. Rates of CS are rising all over the world and so are the rates of vaginal birth after caesarean (VBAC). Attempting a VBAC is a safe and appropriate choice that must be offered to most women who have had a prior caesarean delivery. Approximately 70–75% of women who attempt VBAC will have a successful vaginal delivery. However VBAC is associated with risks for both mother and the baby. The possibility of uterine rupture in labour ranges from 3 to 7 per 1000 pregnancies while the risk of perinatal death or severe morbidity should uterine rupture occur is higher with trial of vaginal delivery than with repeat caesarean delivery. These risks and the associated medico-legal sequelae have resulted in revised national and international guidelines with focus on antenatal counselling, individualised risk assessment as well as stringent facility and personnel requirements to conduct VBAC. [ABSTRACT FROM AUTHOR]

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Aim Vaginal birth after caesarean (VBAC) is a relatively safe alternative to repeat caesarean birth in the proper context. This important decision to undergo an elective caesarean versus VBAC is ultimately a decision of the mother. The purpose of our study was to assess the quality of online information in relation to VBAC collected using the most common search engine: Google. Methods The 10 most common hit sites for the keywords “VBAC” and “Vaginal birth after caesarean” were evaluated using the search engine Google. The quality of websites was rated based on the Silberg scale for accountability, the modified Abbott's criteria for presentation and the SMOG index for readability. The content of each website was compared to the Society of Obstetricians and Gynecologists of Canada (SOGC) guidelines for VBAC. Findings 13 out of 20 identified websites met the adequate criteria for accountability, with 85% of the websites indicating authorship. 11 websites were deemed aesthetically agreeable. The target audience, assessed by the readability score, was notably above the non-medical population with an average SMOG index score of 14.75. Only half of the websites contained recommendations, as detailed by the SOGC guidelines. Conclusion Almost all sites target a higher academic level, making it beyond the comprehension of the general population. Woman friendly web-assessment tools should be provided to enable pregnant women to take an active role in their decision making. [ABSTRACT FROM AUTHOR]

Abstract: Objective: vaginal birth after caesarean (VBAC) is a controversial issue with strong opinions for and against. The means in which women work through the different opinions and options using the internet should be of interest to midwives, obstetricians and policy makers. The aim of this study was to examine how women use English language internet blog sites to discuss the option of VBAC and what factors influence these women''s decision to have a VBAC or repeat caesarean section. Design: a qualitative study using internet blog sites as the source of data was undertaken. Google alerts were created to search for the term VBAC in internet blogs. These alerts were sent to the first author''s email account daily for a one-year period (November 2007 to October 2008) and downloaded. The content was analysed using thematic analysis. Findings: there were 311 blogs mentioning the word VBAC in the one-year period. Most of the blog sites and discussion originated from the USA. There were more blogs written during the Northern Hemisphere winter months than during other seasons. The main theme identified was a dichotomy in philosophical framework women held about birth; that is a ‘motherbirth’ or ‘childbirth’ framework. Whether women eventually wrote that they chose a VBAC or repeat caesarean or the extent to which they pursued their birth choice depended on whether they came from a perspective that a ‘good parent sacrifices themselves for their baby (prioritises the baby) and takes no risks’ (childbirth) or that ‘giving birth matters to the woman and a happy, healthy mother is a happy healthy baby (mother and baby have equal priority)’ (motherbirth). Several themes were identified including: surviving the damage; inadequate bodies; choice and control; fearing and trusting birth; negotiating the system; and minimising or overestimating risk. Key conclusion: women filtered their decision making regarding VBAC through a belief system that prioritises according to their personal approaches. Implications for clinical practice: blogging may be providing a valuable insight into factors that inform decision making and may provide a forum of information and support for women who have experienced a caesarean section. [Copyright &y& Elsevier]

The promulgation of the immediately available physician standard has contributed to the rapid decline in vaginal birth after cesareans (VBACs). While having an immediately available obstetrician during a VBAC trial will reduce risk, it is not clear that similar advantage wouldn''t also accrue to women without uterine scars. However, many hospitals can''t staff up to that standard. In this article we suggest 1) set a goal of providing an immediately available team for all women in labor, 2) tailor informed consent to women''s unique risks– unique because of their own risk profile (e.g., previous scar, hypertension, etc) or unique because of characteristics of the birthing site (e.g. a team is or is not available), 3) in smaller hospitals, if an immediately available team cannot be routinely provided, consideration should be given to bringing in a team for the occasional patient requesting a trial, and to allowing labor for lower risk trials. [Copyright &y& Elsevier]

Childbirth is almost always a wonderful and joyous experience. Parents often begin planning for their baby before they are pregnant. They develop their birth plan and look forward to holding their perfect baby. Sometimes this is just not what happens. Something may occur at conception or during the pregnancy, which causes their joy to shatter, and they experience the most dreadful grief. There are some occasions when problems arise during labor. Although an infrequent occurrence, it adds sorrow and anger to the situation. The case study presented here is that kind of happening. There were mistakes made in recognition of deterioration of the fetal well-being. This lack of recognition and treatment resulted in death of the long awaited baby who would have added joy and not grief to this family. [Copyright &y& Elsevier]

Uterine rupture is the most serious complication for women undergoing trial of labor (TOL) after prior cesarean delivery. While rates of uterine rupture vary significantly according to a variety of clinically associated risk factors, the absolute risk for this complication ranges between 0.5 and 4 percent. Previous vaginal delivery and prior successful vaginal birth after cesarean delivery confer the lowest risk of rupture on women attempting TOL. In contrast, multiple prior cesareans, short interpregnancy interval, single layer uterine closure, prior preterm cesarean, labor induction and augmentation have all been suggested in some studies as factors which may increase the rate of uterine rupture. While considering these risk factors is important in counseling women regarding childbirth following cesarean delivery, the infrequency of uterine rupture coupled with relatively weak associations for most risk factors has prevented the development of an accurate prediction tool for uterine rupture. Preliminary studies suggest that sonographic evaluation of the uterine scar may hold some promise for identifying women at risk. [Copyright &y& Elsevier]

There have been multiple observational studies that have assessed the probability that a woman who undertakes a trial of labor after a previous cesarean delivery will have a vaginal birth. These studies have demonstrated a population-level probability of a successful vaginal birth after cesarean (VBAC) that ranges between 60% and 80%. However, within a population the chances for success of a given individual may vary to a significant degree on the basis of particular demographic characteristics and obstetric history. This review summarizes the different characteristics that have been prominently associated with successful VBAC as well as the different attempts that have been made to develop accurate prediction models for successful VBAC. [Copyright &y& Elsevier]

Objective: The purpose of this study was to assess the maternal morbidity associated with attempted vaginal birth after cesarean (VBAC) in twin gestations using a large, nationwide sample of deliveries. Study design: Data for this study were obtained from an administrative dataset, the Nationwide Inpatient Sample, a representative sample of discharges from non-Federal hospitals, for the years 1993 to 2002. Patients admitted nonemergently for the delivery of twin gestations who had a history of previous cesarean delivery were selected. Patients that either delivered vaginally or who had discharge codes that indicated labor before cesarean delivery were defined as the trial of labor group, while patients who had a cesarean delivery without discharge codes that indicated labor were defined as the elective cesarean group. Various complications of delivery were analyzed for each group. Results: We identified 4705 women who underwent an elective cesarean delivery and 1850 women who underwent a trial of labor. For women who had a trial of labor, 836 (45.2%) delivered vaginally. The rate of uterine rupture was higher in the trial of labor group than in the elective cesarean group (0.9% vs 0.1%, P < .001), and the rate of wound complications was lower (0.6% vs 1.3%, P < .02). The rates of other complications including hysterectomy, transfusion, major postpartum infection, thromboembolism, uterine dehiscence, and pelvic hematoma were not significantly different between the 2 groups. Conclusion: Our study showed a significantly higher rate of uterine rupture in the trial of labor group that is similar to the rates reported for trial of labor after cesarean in singleton pregnancies. [ABSTRACT FROM AUTHOR]

Objective: This study was undertaken to use multivariable methods to develop clinical predictive models for the occurrence of uterine rupture by using both antepartum and early intrapartum factors. Study design: This was a planned secondary analysis from a multicenter case-control study of uterine rupture among women attempting vaginal birth after cesarean (VBAC) delivery. Multivariable methods were used to develop 2 separate clinical predictive indices-one that used only prelabor factors and the other that used both prelabor and early labor factors. These indices were also assessed with the use of Receiver operating characteristic curves. Results: We identified 134 cases of uterine rupture and 665 noncases. No single individual factor is sufficiently sensitive or specific for clinical prediction of uterine rupture. Likewise, the 2 clinical predictive indices were neither sufficiently sensitive nor specific for clinical use (receiver operating characteristic curve [area under the curve] 0.67 and 0.70, respectively). Conclusion: Uterine rupture cannot be predicted with either individual or combinations of clinical factors. This has important clinical and medical-legal implications. [ABSTRACT FROM AUTHOR]

Background: Women who seek vaginal birth after cesarean delivery may find limited in-hospital options. Increasing numbers of women in the United States are delivering by vaginal birth after cesarean delivery out-of-hospital. Little is known about neonatal outcomes among those who deliver by vaginal birth after cesarean delivery in- vs out-of-hospital.Objective: The purpose of this study was to compare neonatal outcomes between women who deliver via vaginal birth after cesarean delivery in-hospital vs out-of-hospital (home and freestanding birth center).Study Design: We conducted a retrospective cohort study using 2007-2010 linked United States birth and death records to compare singleton, term, vertex, nonanomolous, and liveborn neonates who delivered by vaginal birth after cesarean delivery in- or out-of-hospital. Descriptive statistics and multivariate regression analyses were conducted to estimate unadjusted, absolute, and relative birth-setting risk differences. Analyses were stratified by parity and history of vaginal birth. Sensitivity analyses that involved 3 transfer status scenarios were conducted.Results: Of women in the United States with a history of cesarean delivery (n=1,138,813), only a small proportion delivered by vaginal birth after cesarean delivery with the subsequent pregnancy (n=109,970; 9.65%). The proportion of home vaginal birth after cesarean delivery births increased from 1.78-2.45%. A pattern of increased neonatal morbidity was noted in unadjusted analysis (neonatal seizures, Apgar score <7 or <4, neonatal seizures), with higher morbidity noted in the out-of-hospital setting (neonatal seizures, 23 [0.02%] vs 6 [0.19%; P<.001]; Apgar score <7, 2859 [2.68%] vs 139 [4.42%; P<.001; Apgar score <4, 431 [0.4%] vs 23 [0.73; P=.01]). A similar, but nonsignificant, pattern of increased risk was observed for neonatal death and ventilator support among those neonates who were born in the out-of-hospital setting. Multivariate regression estimated that neonates who were born in an out-of-hospital setting had higher odds of poor outcomes (neonatal seizures [adjusted odds ratio, 8.53; 95% confidence interval, 2.87-25.4); Apgar score <7 [adjusted odds ratio, 1.62; 95% confidence interval, 1.35-1.96]; Apgar score <4 [adjusted odds ratio, 1.77; 95% confidence interval, 1.12-2.79]). Although the odds of neonatal death (adjusted odds ratio, 2.1; 95% confidence interval, 0.73-6.05; P=.18) and ventilator support (adjusted odds ratio, 1.36; 95% confidence interval, 0.75-2.46) appeared to be increased in out-of-hospital settings, findings did not reach statistical significance. Women birthing their second child by vaginal birth after cesarean delivery in out-of-hospital settings had higher odds of neonatal morbidity and death compared with women of higher parity. Women who had not birthed vaginally prior to out-of-hospital vaginal birth after cesarean delivery had higher odds of neonatal morbidity and mortality compared with women who had birthed vaginally prior to out-of-hospital vaginal birth after cesarean delivery. Sensitivity analyses generated distributions of plausible alternative estimates by outcome.Conclusion: Fewer than 1 in 10 women in the United States with a previous cesarean delivery delivered by vaginal birth after cesarean delivery in any setting, and increasing proportions of these women delivered in an out-of-hospital setting. Adverse outcomes were more frequent for neonates who were born in an out-of-hospital setting, with risk concentrated among women birthing their second child and women without a history of vaginal birth. This information urgently signals the need to increase availability of in-hospital vaginal birth after cesarean delivery and suggests that there may be benefit associated with increasing options that support physiologic birth and may prevent primary cesarean delivery safely. Results may inform evidence-based recommendations for birthplace among women who seek vaginal birth after cesarean delivery. [ABSTRACT FROM AUTHOR]

Objective: We investigated the effect of interpregnancy body mass index (BMI) change on success of term vaginal birth after cesarean (VBAC) among normal, overweight and obese women. Study Design: Using 1992-2009 Washington State birth certificate data linked with hospitalization records, we conducted a population-based retrospective cohort study of nulliparous women (BMI ≥18.5 kg/m2) with a primary cesarean in their first birth and a term trial of labor in their second. Interpregnancy weight change (difference between first and second prepregnancy BMIs) was categorized as maintenance (<1 BMI unit change), loss (≥1 unit), moderate gain (≥1 and <2 units), high gain (≥2 units). We estimated relative risks of VBAC success using generalized linear models with a log-link function, adjusting for maternal age, race/ethnicity, nativity, marital status, education, smoking, primary cesarean indication, interpregnancy interval, birth year for second birth, and prenatal care adequacy. Results: Among 8302 women who attempted a term trial of labor, 65% had a successful VBAC. Women with normal BMI before their first pregnancy experienced an 8% decrease in VBAC success with moderate gain (relative risk [RR], 0.92; 95% confidence interval [CI], 0.87–0.98) and a 12% decrease in success with high gain (RR, 0.88; 95% CI, 0.83–0.93), compared with normal weight women who maintained weight. Weight loss increased VBAC success in women who were overweight (RR, 1.12; 95% CI, 1.01–1.25) or obese before their first delivery (RR, 1.24; 95% CI, 1.04–1.49), compared with overweight and obese women, respectively, who maintained weight. Conclusion: Women can improve their chance of successful VBAC through interpregnancy weight management. [Copyright &y& Elsevier]

Objective: The purpose of this study was to estimate the effect of gestational age at the time of prior cesarean on maternal morbidity in women attempting vaginal birth after cesarean delivery (VBAC). Study Design: A retrospective cohort study of women attempting VBAC, comparing women with a prior cesarean delivery ≤ 34 completed weeks to women with a prior cesarean delivery > 34 weeks. The primary outcome was maternal morbidity, including uterine rupture. Univariable, stratified, and multivariable analyses were used to estimate the effect of a prior cesarean performed at ≤ 34 weeks on maternal morbidities. Results: Of 19,474 women with 1 prior cesarean, 12,535 attempted VBAC and 508 of those had a previous cesarean ≤ 34 weeks. Study groups had similar risks of uterine rupture (adjusted OR [AOR], 1.5; 95% CI, 0.7-3.5; P = .32) and composite morbidity (AOR, 0.9; 95% CI, 0.5-1.8; P = .81). Conclusion: Prior cesarean delivery at ≤ 34 weeks'' gestation does not appear to increase the risk of maternal morbidity in a subsequent VBAC attempt. [Copyright &y& Elsevier]

Objective: To compare maternal and neonatal outcomes after successful and failed trials of labor after cesarean in women at term, excluding uterine ruptures, and to examine predictors of successful and failed trials of labor. Study Design: Matched maternal and neonatal data from 1993-1999 in women with singleton term pregnancies with prior cesarean undergoing trial of labor were reviewed. Women with uterine rupture were excluded. Maternal and neonatal outcomes were analyzed for successful and failed trials. Predictors of success and failure were examined. Results: 1284 women and their neonates were available for analysis. 1094 (85.2%) had a vaginal birth and 190 (14.8%) underwent repeat cesarean. Failed trials of labor were associated with higher incidence of choriamnionitis (25.8% vs. 5.5%, P<.001), postpartum hemorrhage (35.8% vs. 15.8%, P<.001), hysterectomy (1% vs. 0%, P=.022), neonatal jaundice (17.4% vs.10.2%, P=.004) and composite major neonatal morbidities (6.3% vs. 2.8%, P=.014). Conclusion: Failed trial of labor in women at term with prior cesarean is associated with increased maternal and neonatal morbidities. [Copyright &y& Elsevier]