Do vaginal birth after cesarean outcomes differ based on hospital setting?
OBJECTIVE
The objective of the study was to test the null hypothesis that outcomes of vaginal birth after cesarean (VBAC) do not differ on the basis of the hospital setting.


METHODS
The study was a retrospective cohort study of women who were offered VBAC in 17 hospitals from 1996 to 2000. VBAC attempts occurring in hospitals with and without obstetrics-gynecology residency programs were compared, as were outcomes from university and community hospitals. Bivariate and multivariate logistic regression analyses assessed the association between hospital setting and VBAC outcomes.


RESULTS
Of 25,065 women with 1 or more prior cesareans, the VBAC attempt rate was 56.1% at hospitals with obstetrics-gynecology residencies, 51.3% at hospitals without obstetrics-gynecology residencies, 61% at university hospitals, and 50.4% at community hospitals. The occurrence of failed VBAC, blood transfusion, or composite adverse outcome did not differ by hospital setting. There was a significant increase in the uterine rupture rate at community (1.2%) vs university hospitals (0.6%), but the absolute risk remained low.


CONCLUSIONS
The rate of VBAC-associated complications is low, independent of hospital setting.
DeFranco
Emily A
EA
Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO 63110, USA. defrancoe@wudosis.wustl.edu
Rampersad
Roxane
R
Atkins
Kristin L
KL
Odibo
Anthony O
AO
Stevens
Erika J
EJ
Peipert
Jeffrey F
JF
Stamilio
David M
DM
Macones
George A
GA
D000328:Adult; D015331:Cohort Studies; D005260:Female; D006761:Hospitals / Q000145:classification / Q000706:statistics & numerical data*; D006801:Humans; D011247:Pregnancy; D012189:Retrospective Studies; D014219:Trial of Labor; D016064:Vaginal Birth after Cesarean / Q000706:statistics & numerical data*