Vaginal birth after cesarean success in high-risk women: a population-based study

Objective:the study aim was to identify factors associated with vaginal birth after cesarean (vbac) in high-risk women.study design:this is a population-based retrospective cohort study of all births in ohio during 2006 and 2007. high-risk patients were defined as singleton gestations in women with one previous cesarean who had ⩾1 of the following risk factors: body mass index (bmi)⩾30, hypertension, or diabetes. multivariate logistic regression was utilized to estimate the relative influence of each factor on successful vbac.result:a total of 280 882 births were analyzed: of them, 79 084 (27.1%) were high-risk pregnancies and 8658 (10.9%) women had undergone one previous cesarean; 1433 (16.6%) underwent a trial of labor after cesarean (tolac). of them, 974 (68.0%) had a successful vbac, whereas 459 (32.0%) did not. factors significantly associated with vbac success were as follows: a prior vaginal delivery; pregnancy weight gain ⩽30 lbs; caucasian race; and labor augmentation.conclusion:high-risk women with one prior cesarean are unlikely to undergo a tolac, but have a high rate of vbac.