Journal de la grossesse et de la santé infantile

Abstrait

Prognostic Factors for Vaginal Delivery After Cesarean

Adriano Soares, Horacio Azevedo, Vanessa Silva and Ricardo Sousa-Santos

For women who have undergone a previous cesarean delivery, optimal management of subsequent deliveries is recurrently debated. Despite these risks, it should be noted that a successful and uncomplicated Trial of Labor after Cesarean Delivery (TOLAC) has numerous short and long-term benefits.
Our aim was to study prognosis factors for vaginal delivery in all women with previous Cesarean Section (CS).
A retrospective cohort was conducted with a consecutive sample of 374 women with singleton gestations.
Univariate analysis showed that height ≥ 163 cm ( p<0.05), a previous vaginal delivery ( p<0.05), a Bishop Score ≥ 6 at admission ( p<0.05 ), a spontaneous onset of labour ( p<0.05), a gestacional age ≤ 39 weeks ( p<0.05) and a newborn weight <3500 g ( p<0.05 ) are good prognostic factors for vaginal delivery in women with a previous cesarean. A previous CS motive of cephalopelvic disproportion ( p<0.05) is of poor prognostic factor while fetal malpresentation (p<0.05) is a good prognosis factor when compared with other previous cesarean motives. The multivariate logistic regression analysis showed that the height (p<0.05), onset of labor (p<0.01), gestational age (p<0.01) and the newborn
weight (p<0.01) are independent prognostic factors.
Although vaginal delivery in women previously submitted to cesarean delivery is safe, we may benefit from an approach in which probability of success determines or contraindicates interventions, namely induction of labor.