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To date, several models are available to predict the probability of successful TOLAC.
#Vbag obstetrics trial
This counseling would presumably include individualized risk-benefit assessment of trial of labor with likelihood of successful VBAC It emphasized that pregnant women with a prior cesarean should receive appropriate counseling concerning VBAC versus elective repeat cesarean in order to make an informed decision. The National Institutes of Health Consensus Development Conference Panel released a statement on VBAC in March 2010. Nevertheless, VBAC rates in the United States currently are 8.5%, down from a high of 28.3% in 1996. Best evidence suggests that trial of labor after cesarean (TOLAC) is a reasonable choice for many women, with vaginal birth after cesarean (VBAC) success rates around 75% overall and complication rates less than 1%. Although primary cesarean receives much attention, it accounts for only 50% of the increase in cesarean incidence between 20 because the rate of repeat cesarean deliveries is also increasing markedly.
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Not only is this an all-time high, but it is in epidemic proportion, representing a 53% increase over 10 years starting in 1996. Conclusions: This study provides an accurate and simple model that can be utilized to guide decisions related to TOLAC.Ĭesarean delivery rates in the United States currently exceed 32% of all deliveries.
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This model provided a range of successful probability of VBAC (38-98%) with an area under the receiver operating characteristic curve of 0.723. VBAC success was independently associated with age <30 years, a body mass index <30, prior vaginal delivery, prior VBAC, and absence of a recurrent indication for cesarean. TOLAC was attempted in 599 (22.7%) and resulted in 456 VBACs (76.0%) and 143 repeat cesareans (24.0%). Results: A total of 2,635 deliveries with at least 1 prior cesarean delivery were identified. We critically compared the accuracy of the resulting model to a previously published widely utilized model for predicting VBAC. Associations of these characteristics with VBAC were evaluated with univariate and multivariate logistic regression. Demographic and clinical data were collected. Materials and Methods: Women attempting trial of labor after cesarean delivery (TOLAC) at our institution from Januthrough were evaluated for inclusion. Objective: To develop a model to predict vaginal birth after cesarean (VBAC) in our population and to compare the accuracy of this model to the accuracy of a previously published widely used model.