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- W2049889719 abstract "A recent study showed that once the probability of a successful trial of labor after cesarean delivery (TOLAC) fell below 60% the risk of major morbidity was higher for a TOLAC than a repeat cesarean delivery, even after controlling for maternal weight. We sought to determine if body mass index (BMI) was a significant determinant of successful (TOLAC) and if there was any BMI cut-off in which the rate of a successful TOLAC remained below 60%. This is a retrospective cohort study using data collected for the Consortium of Safe Labor (CSL). The CSL collected electronic medical records from 19 hospitals within 12 institutions (228,668 deliveries from 2002 to 2008). Information on patient characteristics, prenatal complications, labor and delivery data, maternal and neonatal outcomes were collected. Patients were selected for analysis if they had a singleton, live intrauterine pregnancy greater than 37 and 0 weeks gestational age, booking BMI based on research nurse measurements and underwent a TOLAC. The analysis included 5,256 women that were divided into BMI categories of less than 20, 20-24.9, 25-29.9, 30.0-32.9, 33-35.9, 36-38.9, 39-41.9, 42-44.9, greater than 45. The percentage of women undergoing a TOLAC that resulted in a vaginal delivery were calculated with a 95% confidence interval for each BMI group. Based on these success rates a BMI threshold above which a patient has a less than 60% chance of achieving a vaginal birth after cesarean delivery (VBAC) was determined. The overall rate of success of a TOLAC was 61.4%. BMI was inversely correlated with TOLAC success (P<0.001). Women with a BMI greater than 36 have less than 60% chance of acheiving a vaginal delivery after a TOLAC (see table).Tabled 1 We found that successful TOLAC is inversely correlated with BMI. Patients with a BMI greater than 36 should be counseled that it appears that the risk of major morbidity from a repeat cesarean delivery is less than from attempting a TOLAC." @default.
- W2049889719 created "2016-06-24" @default.
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- W2049889719 date "2012-01-01" @default.
- W2049889719 modified "2023-09-26" @default.
- W2049889719 title "661: Trial of labor after cesarean delivery: the impact of BMI" @default.
- W2049889719 doi "https://doi.org/10.1016/j.ajog.2011.10.679" @default.
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