title: Management of vaginal birth after cesarean.
abstract: OBJECTIVE
  To raise the success rate of vaginal birth after cesarean (VBAC) without increasing maternal or perinatal morbidity and mortality rates.
  
  
  METHODS
  Of 468 women with a prior scar, 365 gave valid informed consent for our management of VBAC at Akashi Municipal Hospital during 1986-1999. Trials of labor (TOL) were attempted in 322 cases principally by waiting for spontaneous labor onset and teaching the patients a breathing method to avoid straining until expulsion by vacuum extraction become possible, controlling the intrauterine pressure. Our selection criteria for TOL changed during the trial; from 1991-1999 patients with a prior scar extending into fundus were excluded.
  
  
  RESULTS
  Of the 322 TOL, 88.2% were successful, and VBAC was successful in 77.8% (284 of the 365 patients). Uterine rupture was observed in 2 cases (0.62%). Fetal death occurred in 1 case. Three women gave birth to neonates with a 1-minute Apgar score < or = 6.
  
  
  CONCLUSIONS
  The rate of VBAC was 77.8% in all women with a prior scar. During our management of VBAC, maternal or perinatal morbidity and mortality rates did not increase significantly.
authors.affiliation: Mizunoya Clinic, Akashi, Japan. f-mizunoya@msc.biglobe.ne.jp
authors.forename: Fujio
authors.initials: F
authors.lastname: Mizunoya
authors.forename: Megumi
authors.initials: M
authors.lastname: Nakata
authors.forename: Tokumasa
authors.initials: T
authors.lastname: Kondo
authors.forename: Sadao
authors.initials: S
authors.lastname: Yamashita
authors.forename: Shigeo
authors.initials: S
authors.lastname: Inoue
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D018579:Patient Selection; D011247:Pregnancy; D012189:Retrospective Studies; D014219:Trial of Labor; D014597:Uterine Rupture / Q000209:etiology; D016064:Vaginal Birth after Cesarean