title: The Maternal-Fetal Medicine Units Cesarean Registry: safety and efficacy of a trial of labor in preterm pregnancy after a prior cesarean delivery.
abstract: OBJECTIVE
  This study was undertaken to compare success rates of vaginal birth after cesarean (VBAC) delivery, and uterine rupture as well as maternal/perinatal outcomes between women with preterm and term pregnancies undergoing trial of labor (TOL), and to compare maternal and neonatal morbidities in those women with preterm pregnancies undergoing a TOL versus repeat cesarean delivery without labor (RCD).
  
  
  METHODS
  Prospective 4-year observational study of women with a singleton gestation and a prior cesarean delivery at 19 academic centers. Clinical characteristics, maternal complications and VBAC delivery success for those with a preterm (24(0)-36(6) weeks) TOL, preterm RCD and term TOL (> or = 37 weeks) were analyzed.
  
  
  RESULTS
  Among 3119 preterm pregnancies with prior cesarean delivery, 2338 (75%) underwent a TOL. 15,331 women undergoing TOL at term were also analyzed as a control group. TOL success rates for preterm and term pregnancies were similar (72.8% vs 73.3%, P = .64). Rates of uterine rupture (0.34% vs 0.74%, P = .03) and dehiscence (0.26% vs 0.67%, P = .02) were lower in preterm compared with term TOL. Thromboembolic disease, coagulopathy and transfusion were more common in women undergoing a preterm TOL than those at term. Among women undergoing a preterm TOL, rates of uterine dehiscence, coagulopathy, transfusion, and endometritis were similar to those having a preterm RCD. After controlling for gestational age at delivery and race, neonatal outcomes such as Neonatal Intensive Care Unit (NICU) admission, intraventricular hemorrhage, sepsis, and ventilatory support were similar in both groups except for a higher rate of respiratory distress syndrome in those delivered after a TOL.
  
  
  CONCLUSIONS
  The likelihood of VBAC success after TOL in preterm pregnancies is comparable to term gestations, with a lower risk of uterine rupture. Perinatal outcomes are similar with preterm TOL and RCD. TOL should be considered as an option for women undergoing preterm delivery with a history of prior cesarean delivery.
authors.affiliation: Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH, USA.
authors.forename: Celeste P
authors.initials: CP
authors.lastname: Durnwald
authors.forename: Dwight J
authors.initials: DJ
authors.lastname: Rouse
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Leveno
authors.forename: Catherine Y
authors.initials: CY
authors.lastname: Spong
authors.forename: Cora
authors.initials: C
authors.lastname: MacPherson
authors.forename: Michael W
authors.initials: MW
authors.lastname: Varner
authors.forename: Atef H
authors.initials: AH
authors.lastname: Moawad
authors.forename: Steve N
authors.initials: SN
authors.lastname: Caritis
authors.forename: Margaret
authors.initials: M
authors.lastname: Harper
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Wapner
authors.forename: Yoram
authors.initials: Y
authors.lastname: Sorokin
authors.forename: Menachem
authors.initials: M
authors.lastname: Miodovnik
authors.forename: Marshall
authors.initials: M
authors.lastname: Carpenter
authors.forename: Alan M
authors.initials: AM
authors.lastname: Peaceman
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: O'Sullivan
authors.forename: Baha
authors.initials: B
authors.lastname: Sibai
authors.forename: Oded
authors.initials: O
authors.lastname: Langer
authors.forename: John M
authors.initials: JM
authors.lastname: Thorp
authors.forename: Susan M
authors.initials: SM
authors.lastname: Ramin
authors.forename: Brian M
authors.initials: BM
authors.lastname: Mercer
authors.forename: Steven G
authors.initials: SG
authors.lastname: Gabbe
mesh_terms: D000328:Adult; D005260:Female; D005865:Gestational Age; D006801:Humans; D007752:Obstetric Labor, Premature; D011247:Pregnancy; D011446:Prospective Studies; D012042:Registries; D012449:Safety; D014219:Trial of Labor; D014597:Uterine Rupture / Q000453:epidemiology / Q000517:prevention & control; D016064:Vaginal Birth after Cesarean / Q000009:adverse effects