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Favorable initial pelvic examination, spontaneous labor and a lack of oxytocin use are associated with successful VBAC in women with a single prior low transverse Cesarean delivery and no prior vaginal deliveries. While attempted VBAC and failed VBAC have more maternal infectious morbidity and lower Apgar scores, infant outcomes are similar to those of elective repeat Cesarean delivery.

Objective 17 alpha-hydroxyprogesterone caproate (17-OHPC) reduces recurrent preterm birth (PTB). We hypothesized that single nucleotide polymorphisms (SNPs) in the human progesterone receptor (PGR) will affect response to 17-OHPC in the prevention of recurrent PTB. Study design Secondary analysis of a study of 17-OHPC vs. placebo for recurrent PTB prevention. 20 PGR gene SNPs were studied. Multivariable logistic regression was used to assess for an interaction between PGR genotype and treatment status in modulating the risk of recurrent PTB. Results 380 women were included; 253 (66.6%) received 17-OHPC and 127 (33.4%) received placebo. The majority (61.1%) of women were African-American. Multivariable logistic regression analysis demonstrated significant treatment-genotype interactions for African-Americans delivering <37 weeks' for rs471767 and rs578029, and for Hispanics/Caucasians delivering <37 weeks' for rs500760 and <32 weeks' for rs578029, rs503362, and rs666553. Conclusion The clinical efficacy of 17-OHPC for prevention of recurrent PTB may be altered by PGR gene polymorphisms.

Objective The objective of this study was to perform a randomized controlled feasibility trial investigating negative pressure wound therapy (NPWT) system versus a standard postcesarean wound care (WC) on the development of a postoperative surgical site infection (SSI) and/or a wound dehiscence in obese women. Study Design This is a randomized controlled feasibility trial of obese women undergoing an unscheduled cesarean delivery. Women with an initial body mass index ≥ 30 kg/m2 who were ≥ 4 cm dilated were included. Women were assigned to either a NPWT or standard WC. The primary outcome was a composite of wound morbidity at 4 weeks postpartum including SSI and/or wound opening (clinicaltrials. gov, NCT02128997). Continuous variables were analyzed with t-test and Wilcoxon rank-sum tests and categorical variables with Fisher’s exact test. Results Of 136 women randomized, 67 received NPWT and 69 received standard WC. The 4-week follow-up rate was 88%. Maternal clinical and surgical characteristics were similar between the groups. The prevalence of the composite wound morbidity outcome was not different between those with NPWT and standard WC (4.9 vs. 6.9%; p = 0.71). Conclusion Routine clinical use of a NPWT system after cesarean delivery did not result in a significant reduction of wound morbidity over standard WC.

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