White's classification of maternal diabetes and vaginal birth after cesarean delivery success in women undergoing a trial of labor.
OBJECTIVE
To estimate the rate of vaginal birth after cesarean delivery (VBAC) success in diabetic women based on White's Classification.


METHODS
This is a secondary analysis of an observational study conducted at 19 medical centers of women attempting VBAC. Diabetic women with singleton gestations, one prior cesarean delivery, and cephalic presentation who underwent a trial of labor were included. Vaginal birth after cesarean delivery success rates and maternal and neonatal complications were compared based on White's Classification.


RESULTS
Of 11,856 women who underwent trial of labor, 624 met all study criteria (class A1, 356; A2, 169; B, 70; C, 21; D/R/F, 8). Vaginal birth after cesarean delivery success in each group was: A1, 68.5% (95% confidence interval [CI] 63.4-73.3%); A2, 55% (95% CI 47.2-62.7%); B, 70% (95% CI 57.9-80.4%); C, 47.6% (95% CI 25.7-70.2%); and D/F/R, 12.5% (95% CI 0.3-52.7%). Maternal and neonatal complications were rare and not found to be different among groups.


CONCLUSIONS
Our study provides estimates for VBAC success based on White's classification and indicates a relatively low rate of perinatal complications after VBAC attempt for diabetic women.


METHODS
III.
Cormier
Clint M
CM
From the Departments of Obstetrics and Gynecology University of Texas Health Science Center at Houston, Houston, Texas; The Ohio State University, Columbus, Ohio; University of Alabama at Birmingham, Birmingham Alabama; University of Texas Southwestern Medical Center, Dallas, Texas; University of Utah, Salt Lake City, Utah; University of Pittsburgh, Pittsburgh, Pennsylvania; Thomas Jefferson University, Philadelphia, Pennsylvania; Wayne State University, Detroit, Michigan; University of Cincinnati, Cincinnati, Ohio; Columbia University, New York, New York; Brown University, Providence, Rhode Island; Northwestern University, Chicago, Illinois; University of Miami, Miami, Florida; University of Tennessee, Memphis, Tennessee; University of Texas Health Science Center at San Antonio, San Antonio, Texas; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Case Western Reserve University Cleveland, Ohio, The George Washington University Biostatistics Center, Washington, DC, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
Landon
Mark B
MB
Lai
Yinglei
Y
Spong
Catherine Y
CY
Rouse
Dwight J
DJ
Leveno
Kenneth J
KJ
Varner
Michael W
MW
Simhan
Hyagriv N
HN
Wapner
Ronald J
RJ
Sorokin
Yoram
Y
Miodovnik
Menachem
M
Carpenter
Marshall
M
Peaceman
Alan M
AM
O'Sullivan
Mary J
MJ
Sibai
Baha M
BM
Langer
Oded
O
Thorp
John M
JM
Mercer
Brian M
BM
D000328:Adult; D005260:Female; D006801:Humans; D016015:Logistic Models; D011247:Pregnancy; D011256:Pregnancy Outcome; D011254:Pregnancy in Diabetics; D014219:Trial of Labor; D016064:Vaginal Birth after Cesarean / Q000706:statistics & numerical data*