Cocaine use during pregnancy and the failure of vaginal birth after cesarean.
OBJECTIVE
To evaluate the failure rate of a trial of vaginal birth in women with singleton pregnancies and 1 prior cesarean section who reported using cocaine during the current pregnancy.


METHODS
The medical records of 9254 women who attempted a vaginal birth after cesarean (VBAC) at 16 community and tertiary care hospitals were retrospectively reviewed. VBAC was considered a failure if a woman who was initially considered suited to a trial of VBAC for whatever reason did not succeed in vaginal delivery and had to undergo a repeat cesarean section. We used stratified analysis as well as forward and backward logistic regression analysis to assess the relation between cocaine use during pregnancy and VBAC failure.


RESULTS
Thirteen percent of patients who reported using cocaine had a significant 59% decrease in the odds for VBAC failure in the unadjusted analysis (OR = 0.41, 95% CI= 0.29-0.58) as compared to those who did not report using this substance. Nevertheless, after adjusting for other important predictors of failure and possible confounding variables, the use of cocaine in our final model showed no difference in the odds for VBAC failure (OR = 0.74, 95% CI = 0.49-1.13) as compared to the odds in women who did not report using the drug.


CONCLUSIONS
We could not find any statistically significant difference in the odds for VBAC failure between patients who reported cocaine use during pregnancy and patients who reported those who did not.
Casanova
Bruno F
BF
Department of Obstetrics and Gynecology, Pennsylvania Hospital, University of Pennsylvania, 800 Spruce Street, Philadelphia, PA 19107, USA. casanovb@pahosp.com
Sammel
Mary D
MD
Macones
George A
GA
D000328:Adult; D002585:Cesarean Section; D017604:Cesarean Section, Repeat / Q000706:statistics & numerical data*; D019970:Cocaine-Related Disorders / Q000150:complications*; D005260:Female; D006801:Humans; D015994:Incidence; D007743:Labor, Obstetric; D007744:Obstetric Labor Complications / Q000209:etiology*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D014219:Trial of Labor; D016064:Vaginal Birth after Cesarean / Q000706:statistics & numerical data*