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Creado el : 22 Sep 2005
Alterado em : 01 Dec 2007

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Ficha bibliográfica (sin autores) :

The MFMU Cesarean Registry: Factors affecting the success of trial of labor after previous cesarean delivery. {USA}. American Journal of Obstetrics and Gynecology 2005;193(3 Suppl):1016-1023.

Autores :

Landon MB, Leindecker S, Spong CY, et al.

Año de publicación :

2005

URL(s) :

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=…

Résumé (français)  :

Abstract (English)  :

OBJECTIVE: The purpose of this study was to determine which factors influence the likelihood of successful trial of labor (TOL) after 1 previous cesarean delivery (CD).

STUDY DESIGN: We performed a multicenter 4-year prospective observational study (1999-2002) of all women with previous CD undergoing TOL. Women with term singleton pregnancies with 1 previous low transverse CD or unknown incision were included for analysis.

RESULTS: Fourteen thousand five hundred twenty-nine women underwent TOL, with 10,690 (73.6%) achieving successful VBAC. Women with previous vaginal birth had an 86.6% success rate compared with 60.9% in women without such a history (odds ratio [OR] 4.2; 95% CI 3.8-4.5; P < .001). TOL success rates were affected by previous indication for CD, need for induction or augmentation, cervical dilation on admission, birth weight, race, and maternal body mass index. Multivariate logistic regression analysis identified as predictive of TOL success: previous vaginal delivery (OR 3.9; 95% CI 3.6-4.3), previous indication not being dystocia (CPD/FTP) (OR 1.7; 95% CI 1.5-1.8), spontaneous labor (OR 1.6; 95% CI 1.5-1.8), birth weight <4000 g (OR 2.0; 95% CI 1.8-2.3), and Caucasian race (OR 1.8, 95% CI 1.6-1.9) (all P < .001). The overall TOL success rate in obese women (BMI ≥30) was lower (68.4%) than in nonobese women (79.6%) (P < .001), and when combined with induction and lack of previous vaginal delivery, successful VBAC occurred in only 44.2% of cases.

CONCLUSION: Previous vaginal delivery including previous VBAC is the greatest predictor for successful TOL. Previous indication as dystocia, need for labor induction, or a maternal BMI ≥30 significantly lowers success rates.

Sumário (português)  :

Resumen (español)  :

Comentarios :

Argument (français) :

Les femmes ayant le moins de chance d’aller au bout d’un AVAC sont celles pour qui l’indication de
césarienne était une dystocie, ou qui ont eu un déclenchement, ou qui ont un surpoids important.

Argument (English):

Argumento (português):

Argumento (español):

Palabras claves :

➡ parto vaginal tras cesárea ; cesárea ; inducción del parto ; distocia ; exceder el término ; dilatación

Autor de este registro :

Cécile Loup — 22 Sep 2005
➡ última modificación : Bernard Bel — 01 Dec 2007