OBJECTIVE: Despite the general information of vaginal birth after cesarean section (VBAC), little is known about the duration of active labor in women attempting VBAC. The aim of this study was to compare the time length of active labor in women attempting VBAC compared with nulliparas or multiparas, and then, provide further insight for better management of labor. METHODS: From January 1999 to December 2003, a total of 444 patients with VBAC were entered into the study. Women with two or more history of caesarean section or previous vaginal delivery were all excluded from the study. Time length of active labor in these patients was compared with 335 nulliparas and 218 multiparas consecutively visiting our unit for delivery in 2003. RESULTS: For patients with VBAC, the duration of active and second phase were 184.8+/-115.7, and 25.1+/-15.2 minutes, which was significantly shorter than nulliparas (p<0.05), but longer than multiparas (p<0.05). To eliminate confounding factors affecting the duration, 374 women without use of vacuum, oxytocin, or epidural anesthesia were selected for analysis. Consistently, the time length of active and second phase in women with VBAC was significantly shorter than in nulliparas, but longer than in multiparas (p<0.001) except for active phase compared with nulliparas (p=0.295). CONCLUSION: With regard to the time length of active labor, women attempting VBAC were in the intermediate group when compared with nulliparas or multiparas. Understanding of this unique time interval in women attempting VBAC may help in allowing an appropriate management for labor process.
Anesthesia, Epidural ; Cesarean Section ; Female ; Humans ; Oxytocin ; Pregnancy ; Vacuum ; Vaginal Birth after Cesarean*

OBJECTIVE: The purpose of this report is to determine the predictable factors for successful vaginal birth after cesarean (VBAC). METHODS: In this study, 382 women who attempted VBAC at Kyung-Hee university hospital were included. The medical records of them were reviewed retrospectively. Informations was collected about demographics, medical history, obstetric history, neonatal birth weight, complications, treatment, and outcome of the index pregnancy. RESULTS: The overall success rate was 76.5% (292 cases). Among variables, neonatal birth weight (odds ratio, 0.2; 95% confidence interval, 0.1-0.4), Bishop score at admission (odds ratio, 1.8; 95% confidence interval, 1.5-2.1 ; p<0.05), and history of vaginal delivery (odds ratio, 3.6 ; 95% confidence interval, 1.1-11.6 ; p<0.05) were significant. The Bishop score showed most significant relationship with successful VBAC. The Bishop score 5 at admission had a sensitivity of 47.4% and a specificity of 87.6% in the prediction of successful VBAC. Malpresentation as indications of previous cesarean delivery showed more tendency to succeed than others. CONCLUSION: Several factors such as birth weight, Bishop score at admission, and history of vaginal delivery may be used to predict the success of VBAC.
Birth Weight ; Demography ; Female ; Humans ; Medical Records ; Pregnancy ; Retrospective Studies ; Sensitivity and Specificity ; Vaginal Birth after Cesarean*

PURPOSE: To examine the relationship between weight gain and the success of VBAC by using body mass index (BMI). To examine the relationship between weight gain and the success of VBAC by using body mass index (BMI). METHODS: The study compared clinical features taken from 112 patients who tried VBAC at our institute from January 2001 through December 2006. There were divided into two GROUPS: 92 patients for the success (82.1%) and 20 patients for the failure group (17.9%). Excluding 36 patients with no BMI data, we constructed Receive-operating characteristics (ROC) curve to make the optimum BMI value for the prediction of success of VBAC. Based on the BMI 26 or more, two groups of patient were surveyed the interrelation between weight gain and success of VBAC. RESULTS: Between success and failure group, the weight gain during pregnancy showed significant differences which are 11.2+/-4 kg of the success group and 13.2+/-5 kg of the other one (p<0.05) A survey on the availability of the BMI date to estimate success of VBAC, the criteria with the standard BMI 26 is not statistically valuable (p=0.837). By comparing normal weight and overweight based on BMI 26, some factors showed statistically significant discrepancies: number of prenatal visit, maternal weight gain, maternal weight at the time of delivery, use of oxytocin and birth weight. CONCLUSION: BMI value of 26 has limitations in using as an estimate criteria on success of VBAC. Patients, however, who had relatively small scale of weight gain, showed significant clinical factors to increased success rate of VBAC.
Body Mass Index ; Humans ; Overweight ; Oxytocin ; Parturition ; Pregnancy ; Vaginal Birth after Cesarean ; Weight Gain

OBJECTIVE: This study examined the effect of a maximal cervical dilatation prior to their primary cesarean birth on the time length of labor in women attempting vaginal birth after cesarean section (VBAC). METHODS: From January 2000 to Jun 2005, a total of 526 patients with VBAC were entered into the study. Patients were classified into 4 groups according to the maximal cervical dilatation on the prior cesarean birth: Group 1 (0~3 cm), Group 2 (4~7 cm), Group 3 (8~9 cm), and Group 4 (10 cm). RESULTS: An analysis of the duration of labor showed that the time length of active phase was significantly shorter in each of Group 3 (147.3+/-103.9 minutes) and 4 (155.2+/-104.2 minutes) than in Group 1 (192.9+/-126.0 minutes) or 2 (195.1+/-148.2 minutes) (p<0.05), although there was no difference with regard to the second stage between each group. These results were also sustained even among the selected 248 patients without prior use of oxytocin, vacuum delivery, or epidural anesthesia that could affect the duration of labor. CONCLUSION: The time length of active phase on VBAC is significantly shorter in women with a prior maximal cervical dilatation of > or =8 cm than those without. Study results indicate that prior cervical dilatation may affect the labor time of subsequent VBAC. The proper understanding of the association between prior cervical dilatation and labor time on a subsequent VBAC may be useful for better management or further intervention in the setting of VABC.
Anesthesia, Epidural ; Female ; Humans ; Labor Stage, First* ; Oxytocin ; Parturition ; Pregnancy ; Vacuum ; Vaginal Birth after Cesarean*

Uterine rupture is the important cause of life threatening to mother and fetus, in spite of progressed obstetrics. We must observe the patient carefully before labor, during labor and after delivery for the higher prediction of uterine rupture. We experienced a case of incomplete uterine rupture at 40 weeks of gestation weeks in a 37-year-old multigravida tried vaginal birth after cesarean delivery. So we present it with brief review of literatures.
Adult ; Fetus ; Humans ; Mothers ; Obstetrics ; Pregnancy ; Uterine Rupture* ; Vaginal Birth after Cesarean*

The American College of Obstetricians and Gynecologists (ACOG) has recommended that the most women with one previous cesarean delivery with a low-transverse incision are candidates for vaginal birth after cesarean and should be counseled about VBAC and offered a trial of labor in the hospital which has physicians immediately available to provide emergency care including cesarean section and personnel familiar with the potential complications of a trial of labor who should be vigilant for nonreassuring fetal heart rate patterns and inadequate progress of labor. The safer VBAC will be provided when the physicians and patients are alert about the risk, benefit and disadvantage of VBAC, and when the reasonable management of the labor is performed. The success of VBAC will contribute to prevent unnecessary primary cesarean and reduce the overall cesarean delivery rate.
Cesarean Section ; Emergency Medical Services ; Female ; Heart Rate, Fetal ; Humans ; Pregnancy ; Trial of Labor ; Vaginal Birth after Cesarean

The American College of Obstetricians and Gynecologists (ACOG) has recommended that the most women with one previous cesarean delivery with a low-transverse incision are candidates for vaginal birth after cesarean and should be counseled about VBAC and offered a trial of labor in the hospital which has physicians immediately available to provide emergency care including cesarean section and personnel familiar with the potential complications of a trial of labor who should be vigilant for nonreassuring fetal heart rate patterns and inadequate progress of labor. The safer VBAC will be provided when the physicians and patients are alert about the risk, benefit and disadvantage of VBAC, and when the reasonable management of the labor is performed. The success of VBAC will contribute to prevent unnecessary primary cesarean and reduce the overall cesarean delivery rate.
Cesarean Section ; Emergency Medical Services ; Female ; Heart Rate, Fetal ; Humans ; Pregnancy ; Trial of Labor ; Vaginal Birth after Cesarean

INTRODUCTION: An antenatal scoring system for vaginal birth after caesarean section (VBAC) categorises patients into a low or high probability of successful vaginal delivery. It enables counselling and preparation before labour starts. The current study aims to evaluate the role of Grobman nomogram and the Kalok scoring system in predicting VBAC success in Singapore. METHODS: This is a retrospective study on patients of gestational age 37 weeks 0 day to 41 weeks 0 day who underwent a trial of labour after 1 caesarean section between September 2016 and September 2017 was conducted. Two scoring systems were used to predict VBAC success, a nomogram by Grobman et al. in 2007 and an additive model by Kalok et al. in 2017. RESULTS: A total of 190 patients underwent a trial of labour after caesarean section, of which 103 (54.2%) were successful. The Kalok scoring system (area under curve [AUC] 0.740) was a better predictive model than Grobman nomogram (AUC 0.664). Patient's age (odds ratio [OR] 0.915, 95% CI [confidence interval] 0.844-0.992), body mass index at booking (OR 0.902, 95% CI 0.845-0.962), and history of successful VBAC (OR 4.755, 95% CI 1.248-18.120) were important factors in predicting VBAC. CONCLUSION Neither scoring system was perfect in predicting VBAC among local women. Further customisation of the scoring system to replace ethnicity with the 4 races of Singapore can be made to improve its sensitivity. The factors identified in this study serve as a foundation for developing a population-specific antenatal scoring system for Singapore women who wish to have a trial of VBAC.
Area Under Curve ; Cesarean Section ; Female ; Humans ; Infant ; Pregnancy ; Retrospective Studies ; Trial of Labor ; Vaginal Birth after Cesarean

OBJECTIVES: Vaginal birth or trial of labor after previous cesarean section has become one of the most remarkable changes in obstetric practice. The safety and efficacy of a trial of labor and vaginal birth after previous cesarean are well documented. The purpose of this report is to predict the likelihood of vaginal birth in patients undergoing a trial of labor after previous cesarean delivery using factors known at the time of hospital admission. METHOD: In this retrospective study, 120 women who attempted vaginal birth at Kyung-Hee University Hospital from March 1997 to March 1999. An attempt to identify possible prognostic factors for success of such a trial was made and we evaluated the variables of significant predictive value and the patients' characteristics in the success group and failure group of women who attempted VBAC. RESULT: 87 cases(72.5%) in 120 cases succeeded in VBAC and 33 cases(27.5%) failed. In this comparative groups in VBAC, there was significant difference in CPD index(cephalopelvic disproportion index) and Bishop score, but no significant difference in gestational age, the estimated fetal weight by sonography and newborn birth weight. CONCLUSION: In this study, Bishop score and CPD index and age may be useful and valid predictor of success in VBAC and this information could be particularly valuable. The CPD index may prove most important in determining if a vaginal birth should occur after a cesarean section because it can clearly identify some patients who need a repeat cesarean section.
Birth Weight ; Cesarean Section ; Cesarean Section, Repeat ; Female ; Fetal Weight ; Gestational Age ; Humans ; Infant, Newborn ; Parturition ; Pregnancy ; Retrospective Studies ; Trial of Labor ; Vaginal Birth after Cesarean*

OBJECTIVE: To determine predicting factors associated with successful trials of labor in women attending vaginal birth after cesarean delivery. METHODS: A retrospective chart review from January 1998 through December 2001 of 330 patients (sucess group n=282, failure group n=48) undergoing trials of labor after cesarean delivery at Chonnam National University Hospital. Data were tested for statistical significance with the Student's t-test and the Chi-square test. RESULTS: The following characteristics were found to be statistically significant positive prognostic indicators: lower gestational age (274.0+/-20.6 vs. 281.1+/-7.9 days, p<0.01); higher gravity (1.3+/-0.5 vs. 1.0+/-0.2, p<0.01); higher maternal weight gain during pregnancy (3238+/-543 vs. 3458+/-497 gram, p<0.01); lower birth weight (7.8+/-2.7 vs. 6.6+/-2.5, p<0.01); history of prior trial of labor success (0.17 vs. 0.02, p<0.01), lower birth weight at prior cesarean section (3257+/-460 vs. 3838+/-411 gram, p<0.05). CONCLUSIONS: The characteristics associated with successful trials of labor after cesarean delivery-Bishop score at admission, history of prior vaginal delivery will provide information that may be helpful to the physician and the patient. Trial of labor (probability)=e(13.48+0.14Bishop score+1.06vaginal delivery history-0.001birth weight-0.259gestational age)/1+e(13.48+0.14Bishop score+1.06vaginal delivery history-0.001birth weight-0.259gestational age)
Birth Weight ; Cesarean Section ; Female ; Gestational Age ; Gravitation ; Humans ; Jeollanam-do ; Pregnancy ; Retrospective Studies ; Trial of Labor* ; Vaginal Birth after Cesarean* ; Weight Gain