Trial of labor after cesarean delivery: experience in the non-university level II regional hospital setting.

Abstract

We sought to determine the extent to which vaginal birth after cesarean delivery was attempted since 1987 or 1988 in a representative sample of three regional level II hospitals in Mississippi. The medical record department in each hospital identified all potential study subjects for this retrospective case series. One author abstracted relevant information from each medical record and entered it into a relational data base. Among 18,703 live births, 1574 patients had previous abdominal delivery (8.4%). Trial of labor was undertaken in 286 patients (18%), with an overall successful vaginal delivery rate of 71%. Although success rates for the three level II hospitals were similar (63-81%), utilization rates varied considerably (7-40%). One uterine dehiscence led to hysterectomy; otherwise, there were no serious perinatal complications or differences in measures of maternal morbidity, except for a higher incidence of endomyometritis with failed trial of labor (13 versus 3%). The only consistent differences observed between successful and unsuccessful trials in all groups were length of hospitalization and rate of cervical dilatation in active labor (1.4 versus 0.5 cm/hour). Although each regional level II hospital successfully conducted trials of labor in patients with previous cesarean birth, there was considerable variation among sites regarding frequency of utilization, suggesting a strong influence of nonclinical patient-physician factors upon the decision-making process.