Vaginal Birth After Cesarean Section
(VBAC) Bibliography


Other Years 1916-1989 1990-1994 1995-1999 2000-2004 2005-2009
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compiled primarily by: Philip J. Rosenow, M.D. < philip "at" netpath "dot" net >

HTML and additions by: Ken Turkowski, research scientist

Primary sort by: Date of Publication, Secondary sort by: Author, Last Search: 6/2005

Disclaimer: This bibliography has been made publicly accessible in order to faciltate research by medical professionals. No claim is made for accuracy of the contents, nor is any guarantee made to update it over time, although we have updated it quarterly since 1996. Use at your own discretion.

Author Title Journal vol page yr Abstract
(Eglin AFB)
How safe is vbac for the mother and fetus? J fam Pract 55 149 2006
Safety of VBAC Int J Gyn Ob 92 38 2006 702 patients with Hx of one PCS, divided into group with no previous vaginal delivery and those with a previous vaginal delivery (62%) Found that vaginal delivery occurred more often in those with no Hx of previous vaginal delivery (87.7% versus 79.2%).
Conclusion: these findings indicate that women who have had a CS should strongly consider natural delivery for subsequent pregnancies.
Results of a well defined protocol for a TOL after PCS OG 107 240 2006 Described their management protocol (one PCS, spontaneous labor, Vtx, no prostaglandins, CS if cervix is unripe). Compared 841 women attempting VBAC versus 467 had planned ERCS. There was one uterine rupture found 18 hours after delivery.
Conclusion: With their well-defined protocol, a TOL seems to be a safe as planned CS and the length of stay is shorter.
(U of Penn)
VBAC versus elective repeat CS: assessment of maternal downstream health outcomes BJOG 113 75 2006 Conc: Long-term reproductive consequences of multiple CS should be considered when making policy decisions regarding the risk/benefit ratio of VBAC.
(U at Buffalo)
Temporal trends in the rates of trial of labor in low risk pregnancies and their impact on the rates and success of VBAC AJOG 194 144 2006 The national rate of VBAC has decreased by 55% between 1996 and 2002. Review of 11,446 patients who had a previous Cesarean section looking at trial of labor, VBAC attempts and VBAC success. Found that the success rates were similar during this time but that fewer attempted VBAC suggesting that the decline in VBAC may be due to a decline in trial of labor attempts and not ot a change in success rates.

Author Title Journal vol page yr Abstract
Delivery of dead fetus from inside urinary bladder with uterine perforation: case report and review of the literature Urology 65 797 2005 Case report
Severe obstetric maternal morbidity: a 15-year population based study. JOG 25 7 2005 Looked at 159,896 deliveries and looked for indications of severe maternal morbidity (> 5 blood transfusions, emergency hysterectomy, uterine rupture, eclampsia and ICU admission) There were 313 patients with those markers (257 had one, 42 had 2 12 had 3 and 2 had four) 119 cases of > 5 blood transfusions, 88 emergency hysterectomies, 49 uterine rupture, 46 cases of eclampsia and 83 admissions to ICU.
Rupture of the uterine scar during term labor: contractility or biochemistry? BJOG 112 38 2005 Uterine rupture occurs more frequently in women who have been given prostaglandins, hypothesize that similar to the cervix, prostaglandins induces biochemical changes in the uterine scar favoring dissolution, predisposing the uterus to rupture at the scar of the lower segment. Compared the location of the rupture of the scar in prostaglandins versus elsewhere without prostaglandins. Found that women treated with prostaglandins tend to rupture at the location of the previous scar more frequently than women in the oxytocin group whose rupture tended to occur remote from their old scar.
(Wayne State)
The role of maternal body mass index in outcomes of VBAC. AJOG 193 1517 2005 8580 pats with a PCS, 21.7% had an elective repeat CS, 78.3% had a trial of labor. Found that maternal body mass index correlated inversely with the rate of successful VBAC but not with the rate of uterine rupture.
(U of Penn)
VBAC attempt in twin pregnancies: is it safe? AJOG 193 1050 2005 Multicenter, retro, 25,005 patients with at least one PCS, 535 had twin pregnancies. Found patients with twins were less likely to attempt VBAC but of those that did try, there was no increase in failure, rupture of uterus or major maternal morbidity.
(U of Penn)
Cocaine use during pregnancy and the failure of VBAC JRM 50 663 2005 Retro, 9254 patients attempting VBAC, found no statistically significant difference in the odds for VBAC failure related to cocaine use.
Cecattu Factors associated with VBAC in Brazilian women
Rev Panam Salud Pulbica 18 107 2005 Nested case control study of 1352 patients with a previous CS and who had also at least one subsequent delivery (150 had vaginal delivery and 1202 had subsequent CS) Found that the main determining factors for a vaginal second delivery after a PCS were unfavorable social and economic factors
Sonographic measurement of the lower uterine segment thickness in women with previous CS JOG 27 674 2005 US evaluation of the LUS in 102 patients with one or more PCS. The mean sonographic thickness was 1.8 mm Two women had uterine rupture, both of which had a lower uterine segment of < 1mm.
Previous CS: understanding and satisfaction with mode of delivery in a subsequent pregnancy in patients participating in a formal VBAC counseling program A J Peri 22 217 2005 Survey of patients participating in a formal VBAC educational program. Looked at those who had a successful VBAC, those who chose elective CS and those who had a CS after labor. The most satisfied patients were those who had a successful VBAC, most women valued the opportunity to attempt a VBAC regardless of outcome.
(U of Penn)
Safety and efficacy of VBAC at or beyond 40 weeks gestation OG 106 700 2005 Retro, 11,587 in the cohort attempting VBAC. Found that women past 40 weeks were more likely to have a failed VBAC. (31% versus 22%).
Conc: women beyond 40 weeks gestation can safely attempt VBAC although the risk of VBAC failure is increased.
VBAC: practice patterns of ObGyn JRM 50 261 2005 Survey in July 2003 of ACOG fellows by random sample. 49% said that they were performing more CS than they did 5 years earlier. The reasons given were risk of liability and patient preference. More than 25% of physicians reported that they practiced in hospitals that do not follow the ACOG guidelines. 61% felt competent in determining which patients will have a successful VBAC.
Uterine rupture in Yemen Saudi Med J 26 264 2005 Retro, 5 year all cases of a patient with a ruptured uterus (5547 deliveries, 60 cases of ruptured uterus, 1.1%) 43 cases happened in an unscarred uterus (71.7&) and 17 (28.3%) in a patient with PCS. 93.3% had no prenatal care, 95% presented to the hospital after a long period of obstructed labor. Grand-multiparity was encountered in 69.8% of the no PCS group and 41.2% of the PCS group.
Comparison of maternal satisfaction following vaginal delivery after CS and CS after previous vaginal delivery. Euro J Ob Gyn Reprod Biol 121 56 2005 Questionnaire, found maternal satisfaction with vaginal delivery was high. Those who experienced both preferred a vaginal birth.
Ezegwui Trends in uterine rupture in Enugu, Nigeria JOG 25 260 2005 Retro, 4,333 deliveries with incidence of uterine rupture of 1 in 106 deliveries. Findings included multips, labor < 24 hours and 22% had Pitocin given. 68% of the uterine ruptures had a Hx of a previously scarred uterus and 53% of those were in the lower uterine segment. Perinatal mortality was high
The Utah VBAC study Matern Child Health J 9 181 2005 Examined the effects of ACOG's new guidelines on physicians VBAC practices in Utah via questionnaire. Found the 97% of obstetricians and 79% of family practitioners were aware of guidelines. 45% of all physicians reported a decline in VBAC in the preceding 12 months. 87% had physician immediately available (100% of urban, 88% of suburban and 76% of rural) Found that many rural hospitals are unable to comply with number 5 of recommendations.
(U of Chicago)
Obesity as a risk factor for failed trial of labor in patients with previous cesarean delivery AJOG 192 1423 2005 Review of all singleton deliveries with previous CS, 1998-2002, stratifying by body mass index (BMI). Normal BMI <25, overweight BMI 25-29.9, obese BMI 30-39.9 and morbidly obese BMI >40. Conclusion: obesity is an independent risk factor for failed TOL in patients with a previous CS.
Evidence-based VBAC Best Pract Res Clin Ob Gyn 19 117 2005 Chapter review of the literature about the rising risks of VBAC, patient and management factors that may alter risk, and discusses ongoing research as well as suggestions for improving future research
Hassan Trial of scar and VBAC Jayub Med Coll Abbottabad 17 57 2005 297 patients with Hx of PCS, found that 75% success in a non-recurrent indication for CS.
Hicks Systematic review of the risk of uterine rupture with the use of amnioinfusion after PCS. South Med J 98 458 2005 Medline, Cochran searches.
Conclusion: the use of amnioinfusion in women with PCS who are undergoing a TOL may be a safe procedure, but confirmatory large, controlled prospective studies are needed before definitive recommendations can be made.
Uterine rupture in patients with prior CS: the impact of cervical ripening OGS 60 22 2005 Retro, 972 VBAC attempts, 72% success. There were 33 uterine ruptures at the site of previous cesarean delivery (3.4%). All but 5 ruptures were symptomatic. Induction was more frequent in the uterine rupture group and they were much more likely to have had cervical ripening. The odds ratio for cervical ripening and uterine rupture was 3.93. The risk/benefit ratio would seem to discourage cervical ripening.
Placenta percreta with subsequent uterine rupture at 15 weeks gestation after two previous CS JOG 31 439 2005 Case report
Effect of body mass index and excessive weight gain on success of VBAC. OG 106 741 2005 Divided patients into groups (underweight, normal weight, overweight (BMI 26.1-29) and obese (BMI >29).
Conc: excessive weight gain during pregnancy and obesity both decrease the likelihood of VBAC success.
Uterine rupture after induction of labor in women with PCS BJOG 112 451 2005 Retro, 5 year, 205 patients had their labor induced with Hx. of one PCS. There were 4 cases of uterine rupture and one of dehiscence. 2 babies were profoundly acidotic at birth but all five neonates were healthy when discharged.
Conclusion: In women with PCS and no vaginal deliveries, induction of labor carries a relatively high risk of uterine rupture/dehiscence despite all precautions, including IUPC.
Repeat CS and primary elective CS: recently trained ObGyn practice patterns and opinions AJOG 192 1872 2005 Questionnaire of ObGyn attending 2 review courses. Found that 2/3 of recent graduates are willing to perform an elective CS to prevent pelvic floor injury. Most offer VBAC
Laparoscopic and vaginal repair of uterine scar dehiscence following CS as detected by ultrasound. J Perinatal Med 33 324 2005 Case report of 5 cases of laparoscopic or vaginal repair of uterine scar dehiscence following CS.
(Ohio State)
The MFMU Cesarean registry: factors affecting the success of trial of labor after previous cesarean. AJOG 193 1016 2005 Multicenter, prospective observational study of 10,690 patients attempting VBAC, with a 73.6% success (patients with a previous vaginal delivery attempting VBAC successful 86.6% versus 60.9% in those with no previous vaginal delivery).
Conclusion: Previous vaginal delivery including previous VBAC is the greatest predictor for successful TOL. Previous indication as dystocia, need for labor induction or maternal BMI > 30 significantly lowered success rates.
(Salt Lake City)
A description of the management and outcomes of VBAC in the homebirth setting J Midwifery Womens Health 50 386 2005 Intended home births of 57 patients attempting VBAC. 93% had a spontaneous birth, 97% of those with a previous successful VBAC were again successful, 88% of those without a previous successful VBAC also delivered vaginally. There were no uterine ruptures, there was one fetal demise in a postdate pregnancy with meconium.
Conclusion: Given what is known, VBAC is not recommended in the home birth setting.
Pregnancy after uterine rupture: a report of 5 cases and a review of the OGS 60 613 2005 Case report of 5 pregnancies after a uterine rupture. All were delivered via Cesarean and there were no repeat ruptures.
(U of Penn)
Maternal complications with VBAC: a multicenter study AJOG 193 1656 2005 Case control, found that the incidence of uterine rupture was 9.8/1,000; prior vaginal delivery was associated with a lower risk 0.4/1,000. Prostaglandins alone were not associated with an increase in uterine rupture, sequential of prostaglandin and Pitocin was associated with a rupture rate of 3/1,000. Suggest that inductions requiring sequential agents be avoided.
(U of Penn)
Ob outcomes in women with 2 prior cesarean deliveries: is VBAC a viable option? AJOG 192 123 2005 Compared all patients with 1 versus 2 prior CS attempting VBAC. There were 20,175 patients attempting VBAC after 1 prior CS and 3,970 attempting VBAC after 2 PCS. The rate of success was similar (75.5% versus 74.6%) They found that the risk of morbidity was higher in those attempting VBAC after 2 PCS but that the absolute risk remains low. (Adjusted odds ration 1.61 versus 2.26)
Guidelines for vaginal birth after previous cesarean birth JOG 27 164 2005 Recommendations based on a MEDLINE search
The benefits and risks of inducing labor in patients with PCS: a systematic review BJOG 112 1007 2005 Literature review (Medline, Cochrane, etc) of 162 full text articles.
Conclusion: Women with a Hx of CS attempting a TOL who require induction have a higher rate of CS and have a slightly increased risk of uterine rupture.
(Chelsea and Westminster)
Use of the Atad catheter for the induction of labour in women who have had a PCS – a case series Aust NZ J Ob Gyn 45 325 2005 Use of a catheter in an unfavorable cervix
Induction of labour after a previous Cesarean section: a retrospective study in a district general hospital JOG 25 662 2005 Retro, of patients undergoing induction of labor after a previous CS. Vaginal delivery after induction of labor was attempted in 81 patients of whom 64 (79%) delivered vaginally. There were few complications and no cases of uterine rupture.
Risk factors for bladder injury during CS OG 105 156 2005 42 bladder injuries amongst 14,757 CS. Found PCS more prevalent than controls and found an adjusted risk for bladder injury associated with PCS 3.83.
VBAC rates ae declining rapidly in the rural state of Maine OGS 60 219 2005 The rate of CS has risen from 5.5% in 1970 to 24.7% in 1986. Retro review of delivery records for the state of Maine 1998 to 2001 after ACOG VBAC recommendations. Found a marked drop in VBAC rates in rural hospitals with an overall decrease of 56%.
(U of Penn)
The effect of prematurity on VBAC: success and maternal morbidity OG 105 519 2005 Compared VBAC success and uterine rupture rates between preterm and term gestations in women with Hx of PCS. 20,156 patients with Hx of PCS, 12,463 attempted VBAC. The VBAC success rate for term gestation was 74% and for preterm gestation was 82%. There may be less uterine rupture in the preterm group.
(U of W Ontario)
The impact of labor at term on measures of neonatal outcome AJOG 192 219 2005 Compared neonatal outcome in planned CS, VBAC and normal deliveries. Found that all three had a low level of severe morbidity mortality however VBAC had an increased labor-related severe morbidity/death.
Previous preterm CS: identification of a new risk factor for uterine rupture in VBAC candidates. J Mat Fet Meo Med 18 339 2005 Retro chart review of pts with TOL after PCS looking at gestational age when CS was done. Found 25 uterine ruptures and the risk was higher with a preterm cesarean section. Conclusion: an underdeveloped lower uterine segment in the preterm uterus represents a risk for later rupture. Even if the incision is transverse.
Making choices for childbirth: a randomized controlled trial of decision-aid for informed birth after cesarean. Birth 32 252 2005 Prospective, multicenter randomized controlled trial of 227 pregnant patients with Hx of PCS. One group given a decision-aid booklet describing the risk and benefits of elective repeat CS versus VBAC.
Conclusion: a decision-aid for women facing choices about birth after CS is effective in improving knowledge and reducing decisional conflict. However, little evidence suggested that this process led to an informed choice
Vesicouterine fistulas: imaging findings in 3 cases AJR 184 139 2005 Case report of 3 cases of vesicouterine fistulas, one from a patient with a uterine rupture and one from a patient with a cesarean section. Diagnosis discussed
Predicting cesarean section and uterine rupture among women attempting VBAC Plo S Med 2 E252 2005 Retro review of 23,286 pts attempting VBAC at or before 40 weeks. Randomized into model development and validation groups. The factors associated with emergency CS maternal age, male fetus, no previous vaginal delivery, and prostaglandin induction of labor.
SOGC SOGC clinical practice guidelines. Guidelines for vbac. #155 Int J Gyn Ob 89 319 2005 Guidelines approved by Clinical Practice Obstetrics and Executive Committees of the Society of ObGyn of Canada
Does discussion of possible scar rupture influence preferred mode of delivery after a CS? JOG 25 338 2005 Found that discussion of uterine rupture did not discourage patients in attempting VBAC
(U of Utah)
The maternal fetal medicine unit cesarean registry: trial of labor with twins AJOG 193 135 2005 Looked at twins with Hx of at least one previous CS, 412 patients identified or which 226 had an elective repeat CS. 186 patient's (45.1%) attempted TOL, 120 delivered successfully (654.5% success) 30 of the failed TOL involved a successful vaginal delivery of twin A and a CS for twin B.
Zeteroglu 8 years experience of uterine rupture cases JOG 25 458 2005 Discussed all cases of uterine rupture (40) for an incidence of 0.40%.

ERCS=Elective repeat Cesarean Section, PCS=Prior Cesarean Section, TOL=Trial Of Labor, UR=Uterine Rupture, UD=Uterine Dehiscence, conc.=conclusion, ECV=External Cephalic Version, LTCS=Low Transverse Cesarean Section, LVCS=Low Vertical Cesarean Section, EFM=Electronic Fetal Monitoring, PNM=Peri-Natal Mortality, CPD=Cephalo-Pelvic Disproportion

We have honestly attempted to record everything accurately, however, please refer to original article for any major decisions pertaining to patient care.

Keywords for search:Vaginal Birth After CS, Cesarean Section, Uterine Rupture, Trial of Labor

Philip J. Rosenow, M.D.
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last revised: 2/21/05