Overall the best evidence suggests that VBAC is a reasonable choice for the majority of women. Adverse outcomes were rare for both elective repeat cesarean delivery and trial of labor. Definitive studies are lacking to identify patients who are at greatest risk for adverse outcomes.

Current scored models provide reasonable predictability for VBAC, but none provides consistent ability to identify women at risk for failed trial of labor. A scoring model is needed that incorporates known antepartum factors and can be adjusted for current obstetric factors and labor patterns if induction or augmentation is needed. This would allow women and clinicians to better determine individuals most likely to require repeat cesarean delivery.

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had good-quality or fair-quality evidence relating to uterine rupture. Four studies reported uterine rupture outcomes for both TOL and ERCD and included 47,202 patients, in whom 154 uterine ruptures occurred; 148 ruptures (96%) were in the TOL group. The risk of uterine rupture for all women with a prior cesarean delivery was 0.30% (CI, 0.23%-0.41%) with risks in the TOL and ERCD groups reported as 0.47% (CI, 0.28%-0.77%) and 0.026% (CI, 0.009%-0.082%), respectively. Eight cohort studies (402,059 patients) with a moderate grade of evidence compared risks for hysterectomy between TOL and ERCD groups. The risk of hysterectomy was <0.3% in women with a prior cesarean delivery; the risks between TOL and ERCD were not significantly different (0.17% and 0.28%, respectively; RR 0.65; CI, 0.40-1.06). Nine cohort studies (401,307 patients) had moderate-grade evidence on the rate of transfusion between TOL and ERCD. The overall rates of transfusion did not differ significantly, with rates of 0.9% for TOL and 1.2% for ERCD (RR, 0.81; CI, 0.57-1.15). One study found that the route of delivery influenced the need for transfusion and may be mediated by maternal comorbid conditions. Evidence for hemorrhage was low-grade because of inconsistent and imprecise methods of defining and reporting the occurrence of this complication. From 6 studies involving 47,754 women, the risk rates for hemorrhage with ERCD ranged from 0.3% to 29% and no comparison could be done because of the poor quality of the data. Twenty-two studies with 354,060 patients reported infectious complications, with no significant differences in risk between TOL and ERCD 4.6% (CI, 1.5%-13.5%) and 3.2% (CI, 1.3%-7.3%), respectively. The 4 studies reporting surgical injury and including 53,282 patients had insufficient data to evaluate, with a low grade of evidence. As reported in 8 cohort studies, hospital length of stay was 3.9 d in patients undergoing ERCD and 2.6 d after TOL.Short-term neonatal outcomes included perinatal mortality, respiratory conditions, hypoxic-ischemic encephalopathy, sepsis, trauma, Apgar scores, and neonatal intensive care unit admission. With a moderate grade of evidence, 5 studies reported on perinatal deaths among 75,899 infants. These studies reported only on populations that delivered at term and recorded perinatal mortality through the first 7 d of life. The rate was significantly increased by TOL (0.13%; CI, 0.06%-0.30%) compared with ERCD (0.05%; CI, 0.007%-0.38%). Six studies reported neonatal death (within first 28 d) and included 108,328 infants. The rate of death for TOL was 0.11% (CI, 0.06%-0.20%) compared with 0.06% (CI, 0.02-0.15%) for ERCD, a significant difference. A subanalysis of the data showed that the rates of neonatal mortality were higher in women with high-risk conditions and those with indications for a repeat CD. Respiratory conditions were reported in 6 studies involving 5599 infants. The grade of evidence was low for the 3 studies that compared bag/mask ventilation and 3 other studies that examined transient tac...

No mesh erosions were associated with SH within the first 3 months. In TH, the graft material used may be a modifiable factor needing further investigation. Unexpected abnormal uterine pathologic diagnosis remains a possibility with SH. Longer-term follow-up and a randomized trial are warranted to answer these questions.

Fibromyalgia (FM) patients were recently found to have more symptom burden from bothersome pelvic pain syndromes that women seeking care for pelvic floor disease at a urogynecology clinic. We sought to further characterize pelvic floor symptoms in a larger sample of FM patients using of validated questionnaires. Female listserv members of the Fibromyalgia Information Foundation completed an online survey of three validated questionnaires: the Pelvic Floor Distress Inventory 20 , the Pelvic Pain, Urgency and Frequency Questionnaire (PUF), and the Revised Fibromyalgia Impact Questionnaire (FIQR). Scores were characterized using descriptive statistics. Patients (n = 204 with complete data on 177) were on average 52.3 ± 11.4 years with a mean parity of 2.5 ± 1.9. FM severity based on FIQR score (57.2 ± 14.9) positively correlated with PFDI-20 total 159.08 ± 55.2 (r = .34, p <.001) and PUF total 16.54 ± 7 (r = .36, p <.001). Women with FM report significantly bothersome pelvic floor and urinary symptoms. Fibromyalgia management should include evaluation and treatment of pelvic floor disorders recognizing that pelvic distress and urinary symptoms are associated with more severe FM symptoms. Validated questionnaires, like the ones used in this study, are easily incorporated into clinical practice.Fibromyalgia (FM) is a common, debilitating disorder of widespread pain affecting an estimated 5 million persons in the United States (Lawrence et al., 2008). Similarly, chronic pelvic pain is estimated to affect at least 9 million women (Mathias, Kuppermann, Liberman, Lipschutz, & Steege, 1996), and 4 to 7 million women report bladder pain/ interstitial cystitis symptoms (Berry et al., 2011). Given that these three chronic pain syndromes are highly prevalent, it is not surprising that they often coexist. Indeed, people with FM often report numerous regional pain syndromes, including headaches, temporomandibular disorders, low back/neck pain, myofascial pain, irritable bowel, pelvic pain, and bladder pain (Adams & Denman, 2011;Arnold, Clauw, & McCarberg, 2011;Rodriguez, Afari, & Buchwald, 2009;Williams & Clauw, 2009 Clemens et al., 2014;Adams & Denman, 2011). Pelvic floor disorders negatively influence a woman's activities of daily living, sexual function, bowel and bladder function, and overall quality of life. Despite their high prevalence and negative impact, little known about the relationship between pelvic/bladder symptoms and FM severity. The purpose of this study was to characterize pelvic floor and urinary symptoms in patients with FM. A secondary aim was to describe the strength of the relationship between pelvic floor and urinary symptoms with the total impact of FM. HHS Public Access MATERIALS AND METHODS Design, Participants, and ProceduresThis study was a cross-sectional descriptive survey in women with FM. Five hundred female patients were contacted via e-mail and requested to complete an online "women's health survey" (SurveyMonkey, Inc., Palo Alto, CA Pelvic floor symptoms were measured using the PFDI-...

Younger women experienced greater absolute continence, symptom improvement, and fewer urinary tract infections; both older and younger women had beneficial urgency urinary incontinence episode reduction, similar rates of other treatment adverse events, and improved quality of life.

Cesarean deliveries represent almost one third of US births. Given that repeat cesarean is the most common single indication for cesarean, trial of labor after cesarean (TOLAC) with subsequent vaginal birth after cesarean (VBAC) is an important mechanism to reduce the overall cesarean rate. The 2010 National Institutes of Health Conference found that one of the biggest barriers to VBAC is the lack of patient access to TOLAC. Many women who currently deliver by repeat cesarean would be candidates for a TOLAC. This manuscript will summarize the evidence on VBAC to help clinicians identify candidates, provide evidence-based counseling, and guide management of TOLAC.