title: Labor progress among women attempting a trial of labor after cesarean. Do they have their own rules?
abstract: OBJECTIVE
  To examine the pattern of labor progression among second parous women who had a vaginal birth after a cesarean (VBAC) compared with primiparous and multiparous women who delivered vaginally.
  
  
  METHODS
  Case-control study.
  
  
  METHODS
  University hospital in Israel, August 2005 through November 2008.
  
  
  METHODS
  The cases were all 137 second parous women who had a VBAC during the study period. The control groups were: (1) 136 primiparous women; and (2) 137 women who had a second repeated vaginal delivery.
  
  
  METHODS
  Data were extracted from the electronic medical records at admission, labor charts and medical records at discharge. Controls were frequency-matched to the study group for maternal age, gestational age and the work shift during which the delivery occurred.
  
  
  METHODS
  Length of the active phase of labor. Secondary outcomes were length of the second stage and incidence of vacuum extraction deliveries. Results. The length of the active phase was 176 ± 116, 207 ± 121 and 110 ± 66 minutes in the study, first and second control groups, respectively. The active phase and stage 2 of the study group were significantly shorter than in the first control group (p=0.02 and p=0.007, respectively) and longer than in the second control group (p=0.001 in both stages). The incidence of vacuum deliveries was higher (p=0.001) in the study group (13.9%) compared with the second control group (1.5%).
  
  
  CONCLUSIONS
  The results suggest that the pattern of labor progression among second parous women undergoing a trial of labor after cesarean differs from second parous women undergoing a repeated vaginal delivery. Recognizing this dissimilarity may help in avoiding unnecessary, occasionally deleterious, interventions.
authors: Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel.
authors: Rita
authors: R
authors: Faranesh
authors: Raed
authors: R
authors: Salim
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000293:injuries; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007747:Labor Stage, First; D007748:Labor Stage, Second; D007744:Obstetric Labor Complications; D011247:Pregnancy; D013997:Time Factors; D014219:Trial of Labor; D014620:Vacuum Extraction, Obstetrical / Q000706:statistics & numerical data; D016064:Vaginal Birth after Cesarean