title: Is vaginal birth after cesarean (VBAC) or elective repeat cesarean safer in women with a prior vaginal delivery?
abstract: OBJECTIVE
  This study was undertaken to determine whether vaginal birth after cesarean (VBAC) or elective repeat cesarean delivery is safer overall for a woman with a prior vaginal delivery.
  
  
  METHODS
  This retrospective cohort study of pregnant women from 1996 to 2000 who had a prior cesarean delivery, was conducted in 17 centers. Trained nurses extracted historical and maternal outcome data on subjects by using standardized tools. This planned secondary analysis examined the subcohort that had also previously undergone a vaginal delivery, comparing those who underwent a VBAC trial with those who elected to have a repeat cesarean delivery. Outcomes included uterine rupture, bladder injury, fever, transfusion and a composite (uterine rupture, bladder injury, and artery laceration). We performed bivariate and multivariable analyses.
  
  
  RESULTS
  Of 6619 patients with a prior cesarean delivery who had also had a prior vaginal delivery, 5041 patients attempted a VBAC delivery and 1578 had an elective cesarean delivery. Although there was no significant difference in uterine rupture or bladder injury between the two groups, women who underwent a VBAC attempt were less likely to experience the composite adverse maternal outcome, have a fever, or require a transfusion.
  
  
  CONCLUSIONS
  Among VBAC candidates who have had a prior vaginal delivery, those who attempt a VBAC trial have decreased risk for overall major maternal morbidities, as well as maternal fever and transfusion requirement compared with women who elect repeat cesarean delivery. Physicians should make this more favorable benefit-risk ratio explicit when counseling this patient subpopulation on a trial of labor.
authors.affiliation: Department of Obstetrics and Gynecology, Washington University, St. Louis, MO, USA.
authors.forename: Alison G
authors.initials: AG
authors.lastname: Cahill
authors.forename: David M
authors.initials: DM
authors.lastname: Stamilio
authors.forename: Anthony O
authors.initials: AO
authors.lastname: Odibo
authors.forename: Jeffrey F
authors.initials: JF
authors.lastname: Peipert
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Ratcliffe
authors.forename: Erika J
authors.initials: EJ
authors.lastname: Stevens
authors.forename: Mary D
authors.initials: MD
authors.lastname: Sammel
authors.forename: George A
authors.initials: GA
authors.lastname: Macones
mesh_terms: D000328:Adult; D017604:Cesarean Section, Repeat / Q000009:adverse effects*; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D009017:Morbidity; D011247:Pregnancy; D012189:Retrospective Studies; D012449:Safety; D014219:Trial of Labor; D014597:Uterine Rupture / Q000453:epidemiology; D016064:Vaginal Birth after Cesarean / Q000009:adverse effects*