title: Predicting why women have elective repeat cesarean deliveries and predictors of successful vaginal birth after cesarean.
abstract: OBJECTIVE
  To compare the characteristics of women who select elective repeat cesarean rather than trial of labor after cesarean (TOLAC) for delivery, and to determine individual predictors for success and failure within a TOLAC group and observe differences in maternal and neonatal morbidity.
  
  
  METHODS
  The present descriptive, retrospective, observational study was performed in a regional obstetric unit in the United Kingdom. Data were collected from the Northern Ireland Maternity System database on all women who gave birth between April 2010 and April 2012, and had a previous cesarean delivery, and statistical analysis was performed.
  
  
  RESULTS
  In total, 893 patients were included in the study: 385 underwent TOLAC and 493 underwent elective repeat cesarean. On comparison, women in the elective repeat cesarean group had a shorter inter-delivery interval and fewer had had a previous vaginal delivery (P<0.005). Predictors for success in the TOLAC group included previous vaginal delivery and a longer inter-delivery interval (P<0.05). Successful vaginal birth after cesarean (VBAC) did not have higher rates of maternal morbidity.
  
  
  CONCLUSIONS
  The majority of patients (56%) chose elective repeat cesarean rather than TOLAC, which has long-term implications both clinically and financially. A validated prediction model might improve patient counseling and identify women with a high likelihood of successful VBAC.
authors.affiliation: Department of Obstetrics and Gynaecology, Medicine and Medical Science, University College Dublin, Ireland. Electronic address: fmone@nmh.ie.
authors.forename: Fionnuala
authors.initials: F
authors.lastname: Mone
authors.affiliation: Department of Obstetrics, Altnagelvin Area Hospital, Londonderry, UK.
authors.forename: Conor
authors.initials: C
authors.lastname: Harrity
authors.affiliation: Department of Obstetrics, Altnagelvin Area Hospital, Londonderry, UK.
authors.forename: Brenda
authors.initials: B
authors.lastname: Toner
authors.affiliation: Department of Obstetrics, Altnagelvin Area Hospital, Londonderry, UK.
authors.forename: Aine
authors.initials: A
authors.lastname: Mcnally
authors.affiliation: Department of Obstetrics, Craigavon Area Hospital, Craigavon, UK.
authors.forename: Beverley
authors.initials: B
authors.lastname: Adams
authors.affiliation: Department of Obstetrics, Craigavon Area Hospital, Craigavon, UK.
authors.forename: Aoife
authors.initials: A
authors.lastname: Currie
mesh_terms: D000328:Adult; D017604:Cesarean Section, Repeat / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D011247:Pregnancy; D012189:Retrospective Studies; D014219:Trial of Labor; D016064:Vaginal Birth after Cesarean / Q000706:statistics & numerical data*
keywords: Elective repeat cesarean; Predictors; Trial of labor after cesarean; Vaginal birth after cesarean