Can a prediction model for vaginal birth after cesarean also predict the probability of morbidity related to a trial of labor?
OBJECTIVE
The objective of the study was to determine whether a model for predicting vaginal birth after cesarean (VBAC) can also predict the probabilty of morbidity associated with a trial of labor (TOL).


METHODS
Using a previously published prediction model, we categorized women with 1 prior cesarean by chance of VBAC. Prevalence of maternal and neonatal morbidity was stratfied by probability of VBAC success and delivery approach.


RESULTS
Morbidity became less frequent as the predicted chance of VBAC increased among women who underwent TOL (P < .001) but not elective repeat cesarean section (ERCS) (P > .05). When the predicted chance of VBAC was less than 70%, women undergoing a TOL were more likely to have maternal morbidity (relative risk [RR], 2.2; 95% confidence interval [CI], 1.5-3.1) than those who underwent an ERCS; when the predicted chance of VBAC was at least 70%, total maternal morbidity was not different between the 2 groups (RR, 0.8; 95% CI, 0.5-1.2). The results were similar for neonatal morbidity.


CONCLUSIONS
A prediction model for VBAC provides information regarding the chance of TOL-related morbidity and suggests that maternal morbidity is not greater for those women who undergo TOL than those who undergo ERCS if the chance of VBAC is at least 70%.
Grobman
William A
WA
Department of Obstetrics and Gynecology at Northwestern University, Chicago, IL, USA.
Lai
Yinglei
Y
Landon
Mark B
MB
Spong
Catherine Y
CY
Leveno
Kenneth J
KJ
Rouse
Dwight J
DJ
Varner
Michael W
MW
Moawad
Atef H
AH
Caritis
Steve N
SN
Harper
Margaret
M
Wapner
Ronald J
RJ
Sorokin
Yoram
Y
Miodovnik
Menachem
M
Carpenter
Marshall
M
O'Sullivan
Mary J
MJ
Sibai
Baha M
BM
Langer
Oded
O
Thorp
John M
JM
Ramin
Susan M
SM
Mercer
Brian M
BM
D000328:Adult; D017604:Cesarean Section, Repeat; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D015233:Models, Statistical; D009017:Morbidity; D049451:Nomograms; D011247:Pregnancy; D014219:Trial of Labor; D016064:Vaginal Birth after Cesarean