Choice of Trial of Labor after Cesarean and Association with Likelihood of Success.

OBJECTIVE: To investigate whether the predicted chance of success is associated with the choice to undergo trial of labor after cesarean (TOLAC). STUDY DESIGN: Retrospective cohort study of women with a single prior nonelective cesarean delivering a term singleton in 2012 at a tertiary care hospital. A vaginal birth after cesarean (VBAC) score (likelihood of success) was estimated for each patient. The primary outcome was percentage of women choosing TOLAC among women with favorable (> 70% likelihood) and unfavorable VBAC scores. Other factors such as desired sterilization, provider type, and spontaneous labor were included in the analysis. RESULTS: In 2012, 434 women were eligible: 73 with VBAC score >70%, and 361 with score ≤70%. Of those with score >70%, 63% chose TOLAC, compared with 21% with score ≤70% (p < 0.01). In a multivariable analysis, spontaneous labor onset was highly associated with choosing TOLAC: adjusted odds ratio 26.7 (95% confidence interval 13.86-51.29). The choice of TOLAC was also positively associated with resident provider and desired fertility. CONCLUSION: Almost four in ten women with a history of nonelective primary cesarean and a very high predicted likelihood of VBAC choose elective repeat cesarean. Spontaneous labor was strongly associated with the choice to undergo TOLAC.

Duke Scholars

Author Brenna L Hughes Obstetrics and Gynecology, Maternal Fetal Medicine