title: Maternal complications with vaginal birth after cesarean delivery: a multicenter study.
abstract: OBJECTIVE
  This study was undertaken to determine incidence and risk factors for uterine rupture in women attempting vaginal birth after cesarean delivery (VBAC) in a wide range of hospital settings.
  
  
  METHODS
  We performed a case-control study nested within a cohort of women who have had a prior cesarean to determine the incidence and risk factors for uterine rupture in women attempting VBAC.
  
  
  RESULTS
  The incidence rate of uterine rupture in those who attempt VBAC was 9.8 per 1000. A prior vaginal delivery was associated with a lower risk of uterine rupture (adjusted odds ratio [OR] = 0.40, 95% CI 0.20-0.81). Although prostaglandins alone were not associated with uterine rupture, sequential use of prostaglandin and pitocin was associated with uterine rupture (adjusted OR = 3.07, 95% CI 0.98-9.88).
  
  
  CONCLUSIONS
  Women with a prior cesarean should be offered VBAC, and women with a prior cesarean and prior vaginal delivery should be encouraged to VBAC. Although other studies have suggested that prostaglandins should be avoided, we suggest that inductions requiring sequential agents be avoided.
authors.affiliation: Department of Obstetrics and Gynecology, Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA, USA. gmacones@mail.obgyn.upenn.edu
authors.forename: George A
authors.initials: GA
authors.lastname: Macones
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Peipert
authors.forename: Deborah B
authors.initials: DB
authors.lastname: Nelson
authors.forename: Anthony
authors.initials: A
authors.lastname: Odibo
authors.forename: Erika J
authors.initials: EJ
authors.lastname: Stevens
authors.forename: David M
authors.initials: DM
authors.lastname: Stamilio
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Pare
authors.forename: Michal
authors.initials: M
authors.lastname: Elovitz
authors.forename: Anthony
authors.initials: A
authors.lastname: Sciscione
authors.forename: Mary D
authors.initials: MD
authors.lastname: Sammel
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Ratcliffe
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D015994:Incidence; D011247:Pregnancy; D011248:Pregnancy Complications; D012307:Risk Factors; D014597:Uterine Rupture / Q000453:epidemiology* / Q000209:etiology*; D016064:Vaginal Birth after Cesarean