title: Vaginal birth after cesarean: to induce or not to induce.
abstract: OBJECTIVE
  Our purpose was to determine the impact of labor induction on both the success and safety of a trial of labor in women who are candidates for vaginal birth after cesarean.
  
  
  METHODS
  We performed a prospective observational analysis of 505 women consecutively presenting for delivery with a prior cesarean (September 1997-December 1999), of whom 236 (46.7%) underwent trial of labor. The following three cohorts were established: (1) repeat cesarean without trial of labor (n = 269), (2) spontaneous trial of labor (n = 179), and (3) induced trial of labor (n = 57).
  
  
  RESULTS
  The vaginal delivery rate was significantly higher (77.1% vs 57.9%) in the spontaneous labor group compared with the induced labor group (odds ratio, 2.45; 95% confidence interval, 1.24-4.82; P =.008). Uterine scar separation occurred more frequently in the induced labor group (7%) than in the elective repeat cesarean group (1.5%) (odds ratio, 0.20; 95% confidence interval, 0.04-0.99; P =.034).
  
  
  CONCLUSIONS
  Induction of labor in women attempting vaginal birth after cesarean is associated with a significantly reduced rate of successful vaginal delivery and an increased risk of serious maternal morbidity.
authors.affiliation: Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston 29425, USA.
authors.forename: E J
authors.initials: EJ
authors.lastname: Sims
authors.forename: R B
authors.initials: RB
authors.lastname: Newman
authors.forename: T C
authors.initials: TC
authors.lastname: Hulsey
mesh_terms: D015331:Cohort Studies; D005260:Female; D006801:Humans; D007751:Labor, Induced / Q000009:adverse effects; D016017:Odds Ratio; D011247:Pregnancy; D011446:Prospective Studies; D012449:Safety; D014219:Trial of Labor; D014597:Uterine Rupture / Q000209:etiology; D016064:Vaginal Birth after Cesarean