VBAC Success After Failure to Progress in the Second Stage
abstract & commentary
Synopsis: Women have an excellent chance for a successful vaginal birth after a prior cesarean delivery.
Source: Jongen VHWM, et al. Br J Obstet Gynaecol 1998;105:1079-1081.
To determine the likelihood of a vaginal birth after a prior cesarean delivery (VBAC) performed for delay in descent in the second stage of labor, Jongen and colleagues performed a retrospective follow-up study of primiparous women who delivered at a medical center in the Netherlands between 1986 and 1998. Women were not included in the study if they had a cesarean delivery early in the second stage or because of a non-reassuring fetal heart rate tracing. Of 132 women eligble for the study, 29 had a repeat cesarean delivery while 103 elected to have a trial of labor. Eighty-two (80%) were successful, while 21 (20%) required a second cesarean delivery. Forty-one of 55 women (75%) who had experienced a failed instrumental delivery during their prior labor had a successful VBAC. One uterine dehiscence occurred. No difference was noted in mean birth weight between those patients who had an elective cesarean delivery and those who underwent a trial of labor.
Jongen et al conclude that women who had an arrest of descent in the second stage of labor requiring a cesarean section for their first delivery, including women who had a failed instrumental vaginal delivery birth, have an excellent chance for a successful vaginal birth after a prior cesarean delivery.
COMMENT BY STEVEN G. GABBE, MD
This study from the Netherlands confirms several earlier reports, namely, that women who have required cesarean delivery for failure to progress after reaching full dilatation have a higher probability of a successful VBAC. Even women whose history included a prior failed instrumental birth delivery had a success rate of 75%. These findings are in conflict with those of Hoskins and colleagues who reported a 13% success rate in women who required a cesarean delivery at full dilatation.1 However, that group included only 32 women. Hoskins et al did note that women whose first cesarean delivery was performed at 5 cm or less had a successful VBAC rate of 67%, and those who were delivered by cesarean section at a dilatation of 6-9 cm had a 69% success rate. Jongen et al do not provide data on the difference in birth weight between babies delivered by cesarean section in the index pregnancy and those delivered after a successful VBAC. Women who have required a cesarean delivery after reaching full dilatation are often reluctant to undergo a trial of labor. Despite this fact, the study is very encouraging.
Reference
1. Hoskins IA, et al. Obstet Gynecol 1997;89:591-593.
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