Vaginal birth after cesarean delivery: an admission scoring system.
OBJECTIVE
To develop a scoring system to predict the likelihood of vaginal birth in patients undergoing a trial of labor after previous cesarean delivery using factors known at the time of hospital admission.


METHODS
Trial of labor was attempted in 5022 patients who were assigned randomly to score derivation and score testing groups. Multivariate logistic regression modeling was used in the score derivation group to develop a predictive scoring system for vaginal birth. The scoring system was then applied to the testing group to evaluate its predictive ability.


RESULTS
Five variables significantly affected the mode of birth and were incorporated into a weighted scoring system. Rates of successful vaginal birth after cesarean ranged from 49% in patients scoring 0-2 to 95% in patients scoring 8-10. Increasing score was associated linearly with increasing probability of vaginal birth after cesarean.


CONCLUSIONS
Increasing scores correlate with increasing probability of vaginal birth after cesarean. The admission vaginal birth after cesarean scoring system may be useful in counseling patients regarding the option of vaginal birth or repeat cesarean delivery. This information could be particularly valuable for the patient who opts for trial of labor but has second thoughts about her mode of birth when labor begins.
Flamm
B L
BL
Department of Obstetrics and Gynecology, Kaiser Permanente Medical Centers, Southern California Region, Riverside, USA. bruce.flamm@kp.org
Geiger
A M
AM
D000328:Adult; D005260:Female; D006801:Humans; D016015:Logistic Models; D007744:Obstetric Labor Complications / Q000145:classification* / Q000209:etiology* / Q000628:therapy; D010343:Patient Admission; D011237:Predictive Value of Tests; D011247:Pregnancy; D011446:Prospective Studies; D015203:Reproducibility of Results; D012307:Risk Factors; D012720:Severity of Illness Index; D014219:Trial of Labor; D016064:Vaginal Birth after Cesarean