title: Safety and efficacy of vaginal birth after cesarean attempts at or beyond 40 weeks of gestation.
abstract: OBJECTIVE
  To compare rates of vaginal birth after cesarean (VBAC) failure and major complications in women attempting VBAC before and after the estimated date of delivery (EDD) METHODS: This was a 5-year retrospective cohort study in 17 university and community hospitals of women with at least 1 prior cesarean delivery. Women who attempted VBAC before the EDD were compared with those at or beyond 40 weeks of gestation. Logistic regression analyses were performed to assess the relationship between delivery beyond the EDD and VBAC failure or complication rate.
  
  
  RESULTS
  A total of 11,587 women in the cohort attempted VBAC. Women past 40 weeks of gestation were more likely to have a failed VBAC. After controlling for confounders, the increased risk of a failed VBAC beyond 40 weeks remained significant (31.3% compared with 22.2%, odds ratio 1.36, 95% confidence interval 1.24-1.50). The risk of uterine rupture (1.1% compared with 1.0%) or overall morbidity (2.7% compared with 2.1%) was not significantly increased in the women attempting VBAC beyond the EDD. When the cohort was defined as 41 weeks or more of gestation, the risk of a failed VBAC was again significantly increased (35.4% compared with 24.3%, odds ratio 1.35, 95% confidence interval 1.20-1.53), but the risk of uterine rupture or overall morbidity was not increased.
  
  
  CONCLUSIONS
  Women beyond 40 weeks of gestation can safely attempt VBAC, although the risk of VBAC failure is increased.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. kcoassolo@obgyn.upenn.edu
authors.forename: Kara M
authors.initials: KM
authors.lastname: Coassolo
authors.forename: David M
authors.initials: DM
authors.lastname: Stamilio
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Paré
authors.forename: Jeffrey F
authors.initials: JF
authors.lastname: Peipert
authors.forename: Erika
authors.initials: E
authors.lastname: Stevens
authors.forename: Deborah B
authors.initials: DB
authors.lastname: Nelson
authors.forename: George A
authors.initials: GA
authors.lastname: Macones
mesh_terms: D000328:Adult; D017604:Cesarean Section, Repeat; D015331:Cohort Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D007744:Obstetric Labor Complications / Q000209:etiology*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D017211:Treatment Failure; D014219:Trial of Labor; D016064:Vaginal Birth after Cesarean / Q000009:adverse effects*