title: Vaginal birth after cesarean success in high-risk women: a population-based study.
abstract: OBJECTIVE
  The study aim was to identify factors associated with vaginal birth after cesarean (VBAC) in high-risk women.
  
  
  METHODS
  This is a population-based retrospective cohort study of all births in Ohio during 2006 and 2007. High-risk patients were defined as singleton gestations in women with one previous cesarean who had ⩾1 of the following risk factors: body mass index (BMI)⩾30, hypertension, or diabetes. Multivariate logistic regression was utilized to estimate the relative influence of each factor on successful VBAC.
  
  
  RESULTS
  A total of 280 882 births were analyzed: of them, 79 084 (27.1%) were high-risk pregnancies and 8658 (10.9%) women had undergone one previous cesarean; 1433 (16.6%) underwent a trial of labor after cesarean (TOLAC). Of them, 974 (68.0%) had a successful VBAC, whereas 459 (32.0%) did not. Factors significantly associated with VBAC success were as follows: a prior vaginal delivery; pregnancy weight gain ⩽30 lbs; Caucasian race; and labor augmentation.
  
  
  CONCLUSIONS
  High-risk women with one prior cesarean are unlikely to undergo a TOLAC, but have a high rate of VBAC.
authors.affiliation: Division of Maternal-Fetal Medicine and Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: J
authors.initials: J
authors.lastname: Regan
authors.affiliation: Division of Maternal-Fetal Medicine and Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: C
authors.initials: C
authors.lastname: Keup
authors.affiliation: Division of Maternal-Fetal Medicine and Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: K
authors.initials: K
authors.lastname: Wolfe
authors.affiliation: Division of Maternal-Fetal Medicine and Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: C
authors.initials: C
authors.lastname: Snyder
authors.affiliation: 1] Division of Maternal-Fetal Medicine and Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH, USA [2] Center for Prevention of Preterm Birth, Perinatal Institute Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: E
authors.initials: E
authors.lastname: DeFranco
mesh_terms: D000328:Adult; D015992:Body Mass Index; D005260:Female; D006801:Humans; D016015:Logistic Models; D015999:Multivariate Analysis; D009820:Ohio; D011247:Pregnancy; D018566:Pregnancy, High-Risk / Q000208:ethnology*; D012189:Retrospective Studies; D012307:Risk Factors; D014219:Trial of Labor; D016064:Vaginal Birth after Cesarean / Q000706:statistics & numerical data*; D015430:Weight Gain; D044465:White People