Declining VBAC Rates Despite Improved Delivery Outcomes Compared to Repeat Cesarean Delivery [20Q]

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Abstract

INTRODUCTION:

To describe the incidence and sociodemographic features of vaginal birth after cesarean (VBAC) and to compare delivery-related outcomes of patients undergoing VBAC when compared to repeat cesarean delivery (RCD).

METHODS:

A retrospective cohort study was performed using California discharge data. All deliveries from 2001–2009 were analyzed. VBAC cases as well as other delivery-related morbidities were identified via ICD-9-CM code. Logistic regression was performed to adjust for potential confounders.

RESULTS:

Out of 663,700 women with prior cesarean delivery, 14.2% underwent VBAC. VBAC incidence decreased considerably during the time period, from a peak of 23.7% down to about 10.9%. Caucasians, those with government-funded insurance, and extremes of age had the lowest VBAC rates. VBAC rates were significantly lower in subjects with gestational diabetes, preeclampsia, eclampsia, multiple gestations, preterm delivery, and obesity. There were 234 total cases of uterine rupture identified in the cohort, comprising a uterine rupture rate of 3.5 in 10,000. VBAC, when compared to RCD, was associated with increase in some vaginal delivery related morbidity, such as manual placental extraction, third/fourth degree laceration, and postpartum hemorrhage. RCD, however, was associated with increased rates of postpartum endometritis and anesthesia-related complications, as well as severe morbidities such coagulopathy and hysterectomy.

CONCLUSION:

VBAC levels overall declined during the study period. Subjects with certain co-morbid conditions are less likely to undergo VBAC. Given the overall low uterine rupture rate of VBAC, and evidence of increased serious morbidity of repeat CD, initiatives should be undertaken to encourage providers to offer VBAC to their patients.

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