Obstetrics Research Today is a free monthly online journal that collates and summarizes the latest research about Obstetrics, including details on caesarean delivery, child birth, labour.

Do vaginal birth after cesarean outcomes differ based on hospital setting?

DeFranco EA, Rampersad R, Atkins KL, Odibo AO, Stevens EJ, Peipert JF, Stamilio DM, Macones GA

Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO 63110, USA. defrancoe@wudosis.wustl.edu

OBJECTIVE: The objective of the study was to test the null hypothesis that outcomes of vaginal birth after cesarean (VBAC) do not differ on the basis of the hospital setting. STUDY DESIGN: The study was a retrospective cohort study of women who were offered VBAC in 17 hospitals from 1996 to 2000. VBAC attempts occurring in hospitals with and without obstetrics-gynecology residency programs were compared, as were outcomes from university and community hospitals. Bivariate and multivariate logistic regression analyses assessed the association between hospital setting and VBAC outcomes. RESULTS: Of 25,065 women with 1 or more prior cesareans, the VBAC attempt rate was 56.1% at hospitals with obstetrics-gynecology residencies, 51.3% at hospitals without obstetrics-gynecology residencies, 61% at university hospitals, and 50.4% at community hospitals. The occurrence of failed VBAC, blood transfusion, or composite adverse outcome did not differ by hospital setting. There was a significant increase in the uterine rupture rate at community (1.2%) vs university hospitals (0.6%), but the absolute risk remained low. CONCLUSION: The rate of VBAC-associated complications is low, independent of hospital setting.

Published 1 October 2007 in Am J Obstet Gynecol, 197(4): 400.e1-6.
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