title: Do They Stand a Chance? Vaginal Birth after Cesarean Section in Adolescents Compared to Adult Women.
abstract: OBJECTIVE
  To determine the rate of elective repeat cesarean delivery (CD), vaginal birth after cesarean (VBAC) attempt, and VBAC success in adolescent mothers presenting for delivery of a second child after a prior CD compared to their adult counterparts.
  
  
  METHODS
  Retrospective cohort study analyzing data from the Consortium on Safe Labor Database which includes data for 228,668 deliveries from 2002 to 2008.
  
  
  METHODS
  19 hospitals within 12 institutions in the United States.
  
  
  METHODS
  10,791 women age ≤ 35 (428 adolescents, age ≤ 19 and 10,363 adults age 20-35) with history of prior CD presenting for delivery of a second child.
  
  
  METHODS
  The database was accessed for information on patient characteristics, prenatal comorbidities, and delivery data. Rates of repeat CD, VBAC attempt, and VBAC success were calculated. Multiple logistic regression was applied to identify predictors of VBAC success.
  
  
  RESULTS
  Adolescents had a lower overall repeat CD rate and higher VBAC attempt rate compared to adults (80.61% vs 85.32%, P = .0072; 40.42% vs 30.09%, P < .0001 respectively). VBAC success was similar between adolescents and adults (47.98% vs 48.78% P = .8368). Delivery at a teaching hospital and greater gestational age were predictive of VBAC success. Gestational diabetes mellitus, induction of labor, and higher maternal body mass index were predictive of VBAC failure. Adolescence was not an independent predictor of VBAC outcome.
  
  
  CONCLUSIONS
  Adolescents are more likely to attempt VBAC and are likely to be as successful as their adult counterparts. Adolescents should be encouraged to attempt a trial of labor after prior CD when appropriate to lower the risks of lifelong maternal morbidity from numerous repeat CDs.
authors.affiliation: Department of Women and Infant Services, MedStar Washington Hospital Center, Washington, DC. Electronic address: Lauren.F.Damle@medstar.net.
authors.forename: Lauren F
authors.initials: LF
authors.lastname: Damle
authors.affiliation: Department of Women and Infant Services, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Kathy
authors.initials: K
authors.lastname: Wilson
authors.affiliation: Biostatistics & Epidemiology, MedStar Health Research Institute, Hyattsville, MD.
authors.forename: Chun-Chih
authors.initials: CC
authors.lastname: Huang
authors.affiliation: Department of Obstetrics and Gynecology, MedStar Georgetown University Hospital, Washington, DC.
authors.forename: Helain J
authors.initials: HJ
authors.lastname: Landy
authors.affiliation: Department of Women and Infant Services, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Veronica
authors.initials: V
authors.lastname: Gomez-Lobo
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D005865:Gestational Age; D006801:Humans; D011247:Pregnancy; D012189:Retrospective Studies; D014219:Trial of Labor; D014481:United States; D016064:Vaginal Birth after Cesarean / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Adolescent pregnancy; Trial of labor after cesarean section; Vaginal birth after cesarean section