Predicting the success of vaginal birth after caesarean delivery: a retrospective cohort study in China

Abstract

ObjectivesTo develop a nomogram to predict the likelihood of vaginal birth after caesarean section (VBAC) among women after a previous caesarean section (CS).DesignA retrospective cohort study.SettingTwo secondary hospitals in Guangdong Province, China.ParticipantsInclusion criteria were as follows: pregnant women with singleton fetus, age ≥18 years, had a history of previous CS and scheduled for trial of labour after caesarean delivery (TOLAC). Patients with any of the following were excluded from the study: preterm labour (gestational age <37 weeks), two or more CSs, contradictions for vaginal birth, history of other uterine incision such as myomectomy, and incomplete medical records.Primary outcome measureThe primary outcome was VBAC, which was retrospectively abstracted from computerised medical records by clinical staff.ResultsOf the women who planned for TOLAC, 84.0% (1686/2006) had VBAC. Gestational age, history of vaginal delivery, estimated birth weight, body mass index, spontaneous onset of labour, cervix Bishop score and rupture of membranes were independently associated with VBAC. An area under the receiver operating characteristic curve (AUC) in the prediction model was 0.77 (95% CI 0.73 to 0.81) in the training cohort. The validation set showed good discrimination with an AUC of 0.70 (95% CI 0.60 to 0.79).ConclusionsTOLAC may be a potential strategy for decreasing the CS rate in China. The validated nomogram to predict success of VBAC could be a potential tool for VBAC counselling.

Reasons for previous Cesarean deliveries impact a woman’s independent decision of delivery mode and the success of trial of labor after Cesarean

“…Almost all studies reveal the previous vaginal birth was found to be a strong predictor [2,3,9]. In our study, 96.4% of women with history of vaginal delivery had successful TOLAC.…”

“…A trial of labor after Cesarean (TOLAC) can be a safe alternative and success rates are reported 60-80% [3,[7][8][9][10][11]. Successful TOLAC has many long-and shortterm benefits, including reduced perinatal complications, bleeding, thrombosis, and infection, and later life, chronic pain and ileus [1,[11][12][13].…”

Using healthcare failure mode and effect analysis as a method of vaginal birth after caesarean section management

“…The larger sample size later in 2014–2015, however, provided a more reliable result. Recent domestic reports showed similar VBAC rate, ranging from 76.7%–87.2% (Li et al, ; Xing et al, ; Yang et al, ). In contrast to the rates reported in a literature review between 60%–77% (Tanos & Toney, ), the relatively higher outcome might be caused by the times of previous C‐S.…”

“…The larger sample size later in 2014-2015, however, provided a more reliable result. Recent domestic reports showed similar VBAC rate, ranging from 76.7%-87.2% (Li et al, 2019;Xing et al, 2019;. In contrast to the rates reported in a literature review between 60%-77% (Tanos & Toney, 2019) Our midwifery clinic aims at a caseload model to provide antepartum care for first, second and third trimester so that assessment and guidance can fit in the characteristics of each period.…”

Materno-fetal and neonatal outcomes associated with caesarean section delivery in private and public hospitals in low- and middle-income countries: a systematic review

“…The literature also indicated that other strategies are feasible. Li et al's retrospective cohort study demonstrated that trial of labour after caesarean delivery may be a potential strategy for decreasing the CSD rate [80]. This steady decline of CSD, particularly significant among nulliparous and multiparous births without a uterine scar, which is concomitant with a decline in perinatal mortality from 10.1 per 1,000 births to 7.2 per 1,000 births, is the result of institutional interventions and policy change [81].…”