PREDICTIVE SCORE FOR VAGINAL BIRTH AFTER CESAREAN-SECTION

OBJECTIVE: Our purpose was to evaluate the relative weight of the diff erent variables that may influence the chances of vaginal birth after one cesarean delivery, with the aim of developing a predictive score f or success of such a trial. STUDY DESIGN: In this retrospective study, which covered a 10-year period (1981 to 1990), 471 women who attempte d vaginal birth at a level III university hospital after one abdominal delivery were studied as to the subsequent delivery outcome. An attem pt to identify possible prognostic factors for success of such a trial was made. RESULTS: A trial of labor was successful in 368 (78.1%) of women and 103 (21.9%) had a repeat cesarean section. Variables of sign ificant predictive value were vaginal birth before cesarean section (o dds ratio 1.8), malpresentation (odds ratio 1.9), pregnancy-induced hy pertension (odds ratio 2.3), and Bishop score greater than or equal to 4 (odds ratio 6.0). Cephalopelvic disproportion and failure to progre ss did not demonstrate a significant predictive value (odds ratio 0.81 ) for success or failure in subsequent delivery. In fact, 63.8% of wom en with this indication have Successfully undergone vaginal delivery. Maternal age (odds ratio 0.9) had no bearing on vaginal delivery succe ss rates, whereas both macrosomia (odds ratio 0.2) and intrauterine gr owth retardation tended to decrease the chances for vaginal birth afte r cesarean section. CONCLUSIONS: A trial of labor after one cesarean s ection should be encouraged in most women who are willing to attempt i t, provided no obstetric contraindication exists. A scoring system tha t may help to identify women with a greater chance for vaginal deliver y is proposed.