Vaginal Birth After Cesarean Section
(VBAC) Bibliography

1990-1994

Other Years 1916-1989 1990-1994 1995-1999 2000-2004 2005-2009
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compiled primarily by: Philip J. Rosenow, M.D. < philip "at" netpath "dot" net >

HTML and additions by: Ken Turkowski, research scientist

Primary sort by: Date of Publication, Secondary sort by: Author, Last Search: 6/2005

Disclaimer: This bibliography has been made publicly accessible in order to faciltate research by medical professionals. No claim is made for accuracy of the contents, nor is any guarantee made to update it over time, although we have updated it quarterly since 1996. Use at your own discretion.

1994
Author Title Journal vol pg yr Abstract
ACOG ACOG Committee on Ob:Maternal and Fetal Medicine.       1994 Committee opinion: Guidelines for vaginal del. after PCS
ACOG Fetal Distress and Birth Asphyxia ACOG Comm. Op. 137   1994  
ACOG PRECIS V: An Update in Obstetrics and Gynecology     193 - 4 1994 The most common sign of UR is an abrupt change in FHR, incl. brady. or prolonged decel.; therefore, plans for appropriate management, rapid diagnosis and immediate intervention should be in place prior to undertaking a TOL.
ACOG Vaginal Delivery After a Previous Cesarean Birth ACOG Comm. Op. 143   1994 "...plans for rapid diagnosis and appropriate intervention should be in place prior to undertaking a trial of labor." TOL should occur in a hospital responsive to acute intrapartum emergencies. (replaces #64)
Behrens Induced labor with prost. E2 gel after PCS Gebertshilfe 54 144 1994 385 TOL induction, 161 received prost. E2 gel with 84.9% success after one PCS and 70% after 2 PCS.
Chapman The value of serial US in the management of recurrent uterine scar rupture BJOG 101 549 - 51 1994  
Chattopadhyay Planned vaginal delivery after 2 PCS BJOG 101 498 - 500 1994 Prospective, 115 pts. with 2 prev. CS who underwent TOL compared with 1006 who had repeat CS. 89% delivered vaginally, 68% had spon labor and the remainder had prostaglandin E2. Augmentation of labor was required in 28%. There were no scar dehiscences in those who delivered vaginally, there was dehiscence in the failed TOL and one woman required hyst. Conc.-TOL in pts. with 2 prev. scars appears a reasonable option.
Cowen TOL following cesarean delivery OG 83 933 1994 Prospective, 593 pts. with PCS and TOL, 478 were successful (81%) 67 were induced and 46 had VBAC, 167 received augmentation and 117 delivered. 5 patients experienced true uterine rupture (0.8%) resulting in severe neurologic sequelae in one infant. The only consistent indication of UR was an abrupt and prolonged fetal bradycardia.
Ewen Bladder laceration assoc. with uterine scar rupture Br J Urol 73 712 - 3 1994  
Fawcett
(U of Penn. School of Nursing)		 Responses to VBAC JOG Neonatal Nurs 23 253 - 9 1994 32 pts. who underwent VBAC tested by the Roy Adaptation Model of Nursing. Conc: The women reported both positive and negative aspects of childbearing. The results show a need for high quality nursing and obstetrical care with emphasis on relief of pain and the provision of support and information.
Flamm ERCS versus TOL: a prospective multicenter study. OG 83 927 - 32 1994 7229 pts. with hx. of PCS, 5022 had TOL and 75% were successful. The rate of uterine rupture was <1% and there were no maternal deaths related to UR. The hosp. length of stay, transfusion and pp fever were all higher in repeat CS group. Conc-Neither repeat CS nor TOL is risk free; however, with careful supervision, TOL eliminates the need for a large proportion of repeat CS.
Furbetta Vesicouterine fistulae as complications of repeated CS IJOG 5 240 - 6 1994  
Gardeil Uterine Rupture in pregnancy reviewed Eur JOG Repro Biol 56 107 - 110 1994 Ireland, Review, 1982-1991, excluding cases of asymptomatic uterine scar dehiscence, there were 15 cases of UR in 65K deliveries for an incid of UR of 1 in 4,366 deliveries. There was no case of UR in 21K primigravidas. Only 2/15 occurred in pts without a uterine scar. 12/13 rupture after PCS occurred in the delivery immediately after the PCS. 3 of the 5 perinatal deaths were attrib. to the UR. 10/15 had their labor induced, 5/15 required hyst. 8/15 were Dx in labor and 7 Dx postpartum.
Granovsky - Grisaru
(Israel)		 The management of labor in women with more than one uterine scar: is a repeat CS really the only "safe" option? J Peri Med 22 13 - 7 1994 Prospective, 26 pts. with 2 or more PCS underwent TOL compared with a similar control group. 19 (73%) were successful, there were no cases of UR or perinatal loss. The maternal complication rate was lower in TOL.
Gregory
(Cedars Sinai, LA)		 Repeat CS: how may are elective? OG 84 574 - 8 1994 Reviewed 1885 CS in 1992. The hospital CS rate was 28.7%, 34% of which were repeat CS. Elective repeat was the leading indication followed by "other", dystocia, breech and fetal distress. In contrast, dystocia was the leading cause for primary CS followed by "other", fetal distress, breech. 15.6% undergoing repeat CS had absolute or relative contraindications to VBAC. Conc= current recommendations for lowering CS rates by inc. VBAC are based on aggregate data and do not recognize that some repeat CS are clinically indicated.
Holden Vesicouterine fistula occurring in a women with PCS and 2 subsequent normal vag. del. BJOG 101 354 - 6 1994 Includes case report of vesicouterine fistula occurring spon as a complication of VBAC.
Hueston Factors predicting elective repeat CS OG 83 741 - 744 1994  
Kaplan
(Israel)		 Routine revision of uterine scar after prior CS Acta OG Scand 73 473 1994 467 pts. with VBAC, in 414 the scar was examined transcervically and no dehiscence was detected. Suggest that routine exploration is not necessary.
King Socioeconomic factors and the odds of VBAC. JAMA 272 524 - 9 1994 Retro. of 1989 NY states, 13,944 births in pts. with hx. of PCS, 22% were VBAC. The odds of VBAC increased with maternal education. Conc.-in addition to clinical factors, a mothers level of education, ethnicity and specific char. of the hospital affect the odds of VBAC.
Lelaidier Mifepristone for labor induction after prev. CS BJOG 101 501 1994 Prospect study of 32 pts. with PCS and an unfavorable cx. Received either placebo or 200 mg mifepristone on days one and two of a 4 day observation. Conc.-induction of labor is facilitated in term women with PCS by the use of mifepristone. Safe and useful with no adverse events on the fetus or mother.
Miller
(LAC / USC)		 VBAC: a 10 year experience OG 84 255 - 8 1994 1983-1992 there were 164,815 deliveries at LAC/USC, 17,322 had hx. of PCS. TOL was attempted in 80% with one PCS, 54% with 2 PCS and 30% with 3 or more PCS. The success rate was 83% with one PCS and 75% with 2 or more. Uterine rupture was 3 times more common with 2 or more PCS. TOL yielded a 6.4% lower CS rate with the majority (5.5%) from one PCS. Among TOL there were 3 rupture related perinatal deaths and one maternal death. Conc.-substantial reduction of CS rate can be accomplished safely and efficiently by encouraging a TOL in women with one PCS.
Morton Effect of epidural analgesia for labor on the cesarean delivery rate. OG 83 1045 - 52 1994 A meta analysis of published studies on above topic reveals a 10% increase in sections when epidural was used.
Moskovitz Fetal heart rate monitoring casebook. UR and sinusoidal heart rate JPeri 14 154 - 8 1994  
Mushinski Average charges for uncomplicated CS and vaginal deliveries Stat Bull Metro Ins Co 75 27 1994 During 1993, the average charge among Met Life insured's for a CS was $11,000 compared to $6,430 for vaginal delivery. Physician fees averaged $4,070 for CS and $2,740 for vaginal delivery.
Notzon CS delivery in the 1980s: international comparison by indication. AJOG 170 495 1994 1990 overall USA CS rate was 24%, Sweden was 11% Previous CS and dystocia may be the sources of future reduction in CS rates in the US.
Penso VBAC: an update on physician trends and pt perceptions. Cur Op OG 6 417 - 25 1994 The inc. VBAC can be attrib. to changing physician trends. Women approp for TOL include prev. LVCS, multiple incisions and unknown incision. "limited data show twins, breech and macrosomia not a contraindication". Increased use of Pitocin, ECV, epidural for pain relief and use of PGE gel for cx. ripening. Pt. resistance is still a major deterrent to further rise in VBAC rates.
Potrikovsky Laparoscopic assessment of the integrity of the post CS uterine wall before a TOL. Transcervical Endoscopy Registry JRM 39 464 - 6 1994 52 pts who underwent endoscopic exam. of uterine scar prior to TOL. Scope inserted after ROM, 45 previous incision identified and normal, "compromised" scars were detected in 3 pts and scars were identified as vertical in 4 pts.
Ranzinger Spontaneous rupture of a low transverse CS scar SMJ 87 1001 - 2 1994 Case report, uterine rupture occurs in less than 1% of preg. Case report of spontaneous rupture of a LTCS scar at 36 weeks gestation resulting in fetal death.
Sandmire The Green Bay CS study. III. Falling CS birth rates without a formal curtailment program AJOG 170j 1790 - 802 1994 Observed CS rates at 2 G.B. hosp after 1990 CS study publication. Looked at 1986-1988 and 1990-1992. Total/Primary/Repeat declined from 13.3%/10.2%/8.6% to 6.8%/4.7%/3.4% respectively. Higher CS rates did not result in better perinatal outcome. Literature reports, residency training, CME attendance and liability risks were the major determinants of CS birth as perceived by the 10 physicians in the study.
Schachter
(Israel)		 External cephalic version after PCS--a clinical dilemma. Int JGO 45 17 - 20 1994 11 pts. with breech, hx. of PCS underwent ECV after 36 weeks utilizing ritodrine. All were successful, 6 pts. delivered vaginally and 5 had repeat CS. No scars showed signs of dehiscence. 3 of the 5 infants in the repeat CS gp weighed > 4,000 GMS whereas all the VBAC gp weighed < 3,500.
Stone Use of cx. prostaglandin E2 gel in pts. with PCS Am J Peri 11 309 - 12 1994 Retro, 94 pts with PCS, compared to 866 nullips, both underwent preinduction cx. ripening with 2 mg PGE2 get intracervically. There were no sig. differences in duration of ROM, length of labor, rate/indications for CS, incid of MSAF, maternal or neonatal morbidity. There were no cases of uterine rupture in either gp. Conc-PGE2 gel may be used with the same safety and efficacy in pts with PCS as in nullips.
Turnquest
(University of Louisville)		 VBAC in a university setting J Ky Med ASSOC 92 216 - 21 1994 2757 pts., 282 had hx. of PCS, of the 259 eligible, 84% had TOL and 168/218 had VBAC. There were 6 cases of dehiscence and one uterine rupture. Maternal morbidity was higher in failed TOL pts. Prev. CPD or FTP did not preclude a TOL and 69% were successful.
Turrentine Recurrent Bandl's ring as an etiology for failed VBAC. Am J Peri 11 65 1994 Case report of recurrent Bandl's ring in pt. attempting VBAC.
van der Walt
(South Africa)		 VBAC after one CS Int J Gyn Ob 46 271 - 7 1994 189 pts with hx. of one PCS studied, 44.9% delivered vaginally, 34.4% had a repeat CS during labor and 20.6% had elective CS. In subgroup of babies weighing >2500 GMS, 10.9% of mothers experienced morbidity related to trial of scar. Conc= VBAC accomplished less often in this pop compared with reports from developed countries but the procedure was equally safe.
Yasumitzu Trial of VBAC for arrest disorders of labor: analysis of pts with well documented medical records Asia - Oceania JOG 20 407 - 13 1994 Prospective 6-year study of pts with PCS for arrest disorders. 45 pts with history, 28 had TOL with 75% successful. Differences were with different weights of first and second infant,
Zanconato
(Mozambique)		 Audit of UR in Maputo: a tool for assessment of OB care. Gyn Ob Invest 38 151 - 6 1994 Record review, 96 women with Hx of UR for prevalence of 1 UR in 424 pregnancies. 77% occurred after hospitalization with 22 cases rupturing elsewhere and transferred. Hx of PCS was 46%. Maternal mortality was 7.3% whilst perinatal mortality was 62.9%.
Ziadeh
(Jordan)		 Duration of labor in pts del. vaginally after one prev. lower segment CS Int J Gyn Ob 45 213 - 5 1994 Prospect., 84 pts with PCS for failure to progress had TOL. 58 were successful VBAC, the duration of 1st and 2nd stage of labor was similar, and there was no sig. difference in oxytocin requirements. Conc= pts with PCS for FTP have a duration of labor similar to primip. pts.

1993
Author Title Journal vol pg yr Abstract
  Improving the timeliness of emergency C sect leads to improved care and inc MD satis Qual Lett HJealthc L 5 6 1993 To improve care, concerted effort made to eval reason for lack of response to stat c sect-delays invoked pt. prep, OR setup, pt. transport, lab delays. 88% made ACOG's 30 min
Abitol
(NY)		 VBAC: the patient's point of view. Am Fam Phy 47 129 1993 Interviewed pts. about VBAC and CS. Overall program had a 65% success with VBAC. 40% were not interested in VBAC-convenience and fear of prolonged labor were reasons given. 32% of successful VBAC were dissatisfied with the experience and would have preferred repeat CS.
Bolaji Post cesarean section delivery Eur JOB RepB 51 181 1993 "World wide trend of VBAC reviewed", "watchful waiting is an essential virtue".
Boulot Late vaginal induced abortion after a previous CS: potential for uterine rupture. G O Invest. 36 87 1993 23 pts. for late vaginal induced abortions with hx. of prev. CS, mean gestational age of 23.9 wks. RU 486 and prostag. used. 86.9% were del. vaginally, 3 required CS for lack of dilation. There was one rupture Rx conservatively.
Brody
(Honolulu, HI)		 VBAC in Hawaii. Experience at Kapiolane Medical Center Hawaii MJ 52 38 1993 483 attempted VBAC, 356 (73%) successful, majority of failures were for FTP. Incid. of scar separation was 1.04% (5/483). Pitocin was given in 47 patients, 30 del. vag.
Bussinger VBAC in a rural private setting Nebr Med J 78 358 1993  
Clemenson Promoting VBAC Am Fam Phys 47 139 1993 New data support the safety of VBAC. Physicians that provide standard OB care can also provide care for women attempting VBAC. Family physicians can play a major role in promoting VBAC in approp. patients.
Crane Rx of OB hemorrhagic emergencies Cur Opin OG 5 675 1993 Review of management of hemorrhagic complications.
Elkady
(Egypt)		 A review of 126 cases of UR Int Surg 78 231 - 5 1993 Retro, 1979-88, 126 cases of UR in 46,207 del. for incid of 1/367. 43% were traumatic UR and 57% for spontaneous UR. Maternal mortality was 21% and perinatal mortality was 73%.
Flannelly Rupture of the uterus in Dublin: an update J Ob Gyn 13 440 - 443 1993 78,489 deliveries, 27 cases of UR in multigravid, there were no UR cases in primigravidas. 8/48,718 unscarred uteri ruptured whereas 19/2842 previously scarred uteri ruptured (0.02% versus 0.7%). PPH was the most common sign of UR in the unscarred uterus, fetal distress was the most common findings in a scarred uterus. There were no maternal deaths, there were 12 perinatal deaths (45%).
Goldman
(U of Montreal)		 Factors influencing the practice of VBAC AJ Pub H 83 1104 1993 Case control, 635/2593 controls, found that higher likelihood VBAC if MD's CS rate less than 20%, high risk rate less than 5% and his age <54, Hosp tertiary referral and pt. have a low level of education.
Jakobi Eval of prognostic factors for VBAC JRM 38 729 1993 261 pts. attempting VBAC, found 6 sig. factors predicting success (but abstract did not list them), 94.5% successful predicted but predictive value of failure was only 33%.
Jones StORQS: Washington's statewide OB review and quality system: overview and provider evaluation. QRB - Qual - Rev Bul 19 110 - 8 1993 3 admin. databases, showed a high degree of variability across hosp. for CS, VBAC and forceps del.
Kline
(St John's Mercy Medical Center, St. Louis, MO)		 Analysis of factors deter. the selection of repeated CS or TOL JRM 38 289 1993 241 pts. with prev. CS: 120 had elective repeats, 121 attempted VBAC. More pts. opted for repeat if first was for FTP. More pts. in VBAC gp had first for fetal distress. Factors for attempt for VBAC were-81% pts. desire, 12% MD's advice+pts. desire and 7% just MD's advice. Reasons for repeat were 46% medical indications, 32% pts. desires and physicians advice, 13% physicians advice.
Lai Del. after a lower seg. CS Sing Med J 34 62 1993 Retro., 130 pts. with prior CS, 76% were selected for trial of labor, 65% were successful. There was a 0.7% incid. of uterine dehiscence and a perinatal mortality of 10/1000 with no maternal mortality. CPD and prev. cx. dilation were not important prognostic factors.
Leung
(LAC/USC)		 Risk factors assoc. with uterine rupture during TOL after CS: a case control AJOG 168 1358 1993 Case control, 70 cases of uterine rupture, risk factors are excessive Pitocin, dysfunctional labor and hx. of 2 or more CS. Recog of active phase arrest disorder, despite adeq augmentation with Pitocin requires operative delivery.
Leung
(LAC/USC)		 Uterine Rupture after previous cesarean delivery: Maternal and fetal consequences. AJOG 169 945 1993 Retro., 106 cases of uterine rupture (7 charts incomplete -- 99 cases studied), 28 cases were complete fetal extrusion, 13 partial and 58 had no fetal extrusion. There was one maternal death. Complete extrusion was associated with a higher fetal mortality (14%) and morbidity. Sig neonatal morbidity occurred when >18 minutes elapsed between the onset of prolonged deceleration and delivery. Conc=maternal and neonatal complications in uterine rupture are low with prompt intervention.
Myers
(Mt Sinai, Chicago)		 The Mount Sinai CS reduction program: an update after 6 years Soc Sci Med 37 1219 1993 F/u on program to reduce CS rates. Two prerequisites remain critical to reducing CS rates: must be accomplished without harm to mother or baby and a target rate was prospectively determined. They achieved rates of 10-12% without adverse outcome.
Norman Elective Repeat CS: how many could be vaginal births CMA 149 431 1993 Retro., 313 pts., only 30% had TOL, (71% elig by guidelines of Nat Consensus Conf 1986 and 13% more elig by 1991), of 220 repeats only 11% had VBAC discussion noted in chart.
Raynor
(Roanoke Rapids, NC)		 Experience with VBAC in a small rural community practice. AJOG 168 60 1993 Retro., 67 pts. with hx. CS, 76% had TOL, and 61% were successful. 2 uterine ruptures occurred, neither assoc. with labor.
Rock Variability and consistency of rates of primary and repeat CS among hospitals in 2 states. Pub Heal Rep 108 514 1993 New York & Illinois found wide variation in rates. Hosp CS rate was consistent during study.
Ryding Investigation of 33 women who demanded a CS for personal reasons Acta OG Scand 72 280 1993  
Sato UR during TOL in a case with a unicornuate uterus and a prev. CS GO Invest. 36 124 1993 Case report of uterine rupture during labor in a pt. with prev. CS and a unicornuate uterus. Conc.-do repeat in this circumstance.
Shalev ECV at term using tocolysis Acta OG Scand 72 455 1993 Case reports of 55 pts with non vertex at 37-40 wks. 8 pts had PCS, 6 underwent ECV successfully with 2 of those successful in VBAC.
Socol
(Northwestern U, IL)		 Reducing CS at a primary private university AJOG 168 1748 1993 Northwestern hosp-had CS rate of 27% in 86 -- VBAC strongly encouraged. Individual physicians CS rates published and active management of labor standard, total/primary/repeats decreased 27%/18%/9% to 17%/10.6%/6.4%. (dec CS for dystocia and inc VBAC).
Soliman
(Manchester University, Ontario)		 CS: analysis of experience before and after the Nat. Consensus Conf. CMAJ 148 1315 1993 Compared 1982 with 1990, VBAC offered 93% more often in 1990, rate of vag. del. inc only 2.6% (reducing the CS rate by 8.7%). Induction of labor is currently the most important correctable predictor of CS rate, active management of dystocia, breech management and fetal distress diagnosis "need to be improved."
Stanco
(LAC - USC)		 Emergency peripartum hyst, and assoc. risk factors AJOG 168 879 - 83 1993 Retro and cohort, 1985-90. 123 cases of emergency peripartum hyst. (1.3/1,000 births) 61 for placenta accreta, 25 for uterine atony, 19 for unspecified bleeding and 14 for UR.
Thorp The Effect of Intrapartum Epidural Analgesia on Nulliparous Labor: A Randomized, Controlled, Prospective Trial AJOG 169 851 - 858 1993 Nulliparas in spontaneous labor were randomized to epidural (n=48) or narcotic (n=45) analgesia. The only cesarean in the narcotic group was the only woman who opted out into the epidural group. The risk of cesarean with epidural was 50% at 2cm, 33% at 3cm, 26% at 4cm, and nil at 5cm. They stopped the study early on ethical grounds when the results became clear to the researchers.
Thubisi VBAC: is X ray pelvimetry necessary? BJOG 100 421 1993 Prospective, controlled, 366 assigned x ray or no x ray at 36 wks. Conc= x ray pelvimetry is poor predictor of outcome and inc CS rate. (controls had much higher rate of successful VBAC versus x ray gp).
Tucker TOL after a one or two layer closure of a LTCS AJOG 168 545 1993 292 pts, the incid of scar separation was low and not affected by the method of uterine closure. A LTCS closed in one continuous layer should not preclude a subsequent TOL.
Vedat
(Turkey)		 UR in labor: a review of 150 cases Isr JMed Sci 29 639 1993 8 year period, 150 cases of UR for incid. of 1/966 deliveries. 114 occurred in pts with PCS. Rupture of unscarred uterus is a more catastrophic event. Etio-grandmultips, CPD, fetal malpresentation and oxytocin stimulation of labor. 32.2% perinatal mortality but only 2% maternal mortality. Hyst. commonly performed.
Walton VBAC. Acceptance and outcome at a rural hosp JRM 38 716 1993 Retro., 62 pts., 88% of those ultimately undergoing trial were successful.

1992
Author Title Journal vol pg yr Abstract
Abraham
(Israel)		 Delay in Dx of rupture of the uterus due to epidural anes. GO Invest 33 239 1992 Case report of UR with epidural anes.
Arulkumaran
(National Univ Hosp, Singapore)		 Sx and Signs with UR,-value of uterine pressure monitoring Aus NZ JOG 32 208 1992 Retro., 1018 pts. with prev. CS, 722 (71%) had TOL with 70% success. there were 4 (0.55%) partial and 5 (0.69%) complete uterine scar rupture. All nine had oxytocin, 3 of the 6 with rupture Dx prior to del. had sudden reduction in uterine activity, one had scar pain and prolonged bradycardia, 2 had no signs or Sx.
Bakri
(Saudi Arabia)		 Preg. complicated by malaria, precipitate labor and UR IJOG 38 231 - 3 1992 Case report of pt with malaria, 3 PCS developing precipitate labor complicated by UR, stillborn, bladder and vaginal laceration necessitating hyst.
Blanco PGE 2 gel induction of pts. with prev. LTCS (Texas Tech) AJPeri 9 80 1992 25 pts. with unfav. cx. and prev. LTCS compared with 56 prev. LTCS and labor. Groups comparable, no UR or UD.
Chelmow
(New England Med Center, Mass)		 Maternal and Neonatal outcomes after Pitocin aug. in pts. undergoing TOL after PCS OG 80 966 1992 Retro., 1975-90 pts. whose labors were augmented with Pitocin were compared with women with labor abn. managed without Pitocin. 504 TOL, 37% had labor abnormalities-34% of these received Pitocin. 58% of TOL were successful. In those since 1982, 73% had VBAC, 74% of pts. who received Pitocin del. vag. There were no mat deaths, UR or hyst. Conc Pitocin and epidurals safe for VBAC.
Chen
(Taiwan)		 UR: an 8 year clinical analysis and review of the literature Chang Keng IHsueh 15 15 - 22 1992 9 cases of UR for incid of 1 in 3871. 6 of 9 involved an intact uterus with the others having hx. of PCS. The common factor of UR in an intact uterus was injudicious use of a uterine stimulant whereas the common etio. of UR of a scarred uterus was a previous scar rupture or dehiscence. There was no maternal mortality but 33% fetal mortality (all in UR of intact uterus).
Dagher Uterine and bladder rupture during vaginal delivery in a pt. with a PCS: case report Urol Radiol 14 200 - 1 1992 Case report.
Devoe Prediction of "controlled" UR by the use of IU pressure cath OG 80 626 1992 Uterine. pressure measured during CS, did not help predict UR
Duff Issues in OB, VBAC Audio Digest 39   1992 Tape presentation, 4% incid of CS in 1950, now is near 25% and 40% in some hosp. Reasons for increase: 46% repeat CS, 20% dec. in mid forceps, 15% inc. in Dx of fetal distress, 12% for breech presentation. Indications for CS now are: 30% dystocia, 35% repeat CS, 10% fetal distress, malpresentations, twins, prematurity, medical complications. VBAC risk of rupture is 0.5-3%, usually asymptomatic, risk of rupture is not increased with second CS. 70% of VBAC will be successful. VBAC management: continuous fetal monitor, effective analgesia (epidural OK), examination of scar after del (repair small defect in unstable patient or any defect > 4 cm. Risks of VBAC: scar disruption, infection, if CS required will have inc. blood loss, bladder and bowel injuries. Factors in success of VBAC: prior indication not CPD, previous successful VBAC, EFW < than prev. child.
Flamm Should Electronic fetal monitoring always be used for women in labor for VBAC Birth 19 31 - 5 1992  
Gemer Detection of scar dehis. at del. in women with prior CS Acta OGS 71 540 1992 Retro., 1023 pts. attempt VBAC, 475 del. vag., 13 cases of scar separation found at lap, only 1 found with manual exploration. i.e. manual exploration not justified with successful VBAC.
Holland
(U of Miss.)		 TOL after PCS: experience in the non Univ. level II regional hosp. setting OG 79 936 1992 Retro., Mississippi, 18,703 live births, 1574 had prev. CS (8.4%). 18% of these PCS's had TOL with success of 71%. One UD lead to hyst.
Hsu
(Johns Hopkins)		 Rupture of uterine scar with extensive bladder lac after cocaine AJOG 167 129 1992 Case of rupture with extensive bladder injury with cocaine.
Jackson
(U of Utah)		 Prenatal care for the normal patient Cur Opin OG 4 792 1992 Screening protocols for the low risk patient.
Lee
(Minnesota)		 Spon bladder and UR with attempted VBAC JUro 147 691 1992 Case present., gross hematuria while Pitocin aug, fetal distress.
Maymon
(Israel)		 Third- trimester UR after PG E2 use for labor induction JRM 37 449 1992 9 cases reported in English lit of rupture after PG E2, although is rare "no prostaglandin compound is exempt."
Miller
(Sydney)		 VBAC Aus NZJOG 32 213 1992 318 pts. with PCS, 193 (61%) had repeat, 125 (39%) had TOL with 64% success. UR rate was 0.8%.
Mor-Yosif The Israel perinatal census Asia Oceania J OG 18 139 1992 60-80% success for TOL
Nguyen
(U of Texas Med. Galveston)		 VBAC at the U of Texas JRM 37 880 1992 242 underwent TOL, 76% successful, 1.7% had separation of the uterine scar. Prior breech had highest success-86%, use of epidural and Pitocin may inc success.
Norman
(Sweden)		 Preinduct cx. ripening with PG E2 in women with one prev. CS Acta OGS 71 351 1992 30 pts. attempt VBAC with PG E2, 27% had CS, 1 episode of hyper contractility, "can be used".
Nyirjesy VBAC in rural Zaire JRM 37 457 - 60 1992 33 offered VBAC, 22 successful. There was a high rate of maternal morbidity but no long term morbidity. The rate of uterine dehiscence was 9.1%.
Pickhardt
(U of Miss.)		 VBAC: are there useful and valid predictors of success/fail? AJOG 166 1811 1992 No element identified as predictor of success/failure -- all should attempt.
Pridjian
(U of Michigan)		 Labor after prior CS Clin OG 35 445 1992 All PCS candidates for VBAC, needs full informed consent, management like any labor: monitoring, labor disorders Dx and Rx promptly, avoid uterine hyperstim. UR has multiple presentations, however, most common are fetal bradycardia and variable decel. Most UR can be repaired. Hx. of prior UR is not a contraindication to future children but may place at inc risk for repeat event.
Spalding Del. through the maternal bladder during TOL OG 80 512 1992 2 cases of infant del. through the maternal bladder, one after UD and the other after vaginal rupture after TOL. Conc-standard and unique complications are reported with TOL.
Stone
(Mt Sinai Medical Center, NY)		 Morbidity of failed labor in pts. with PCS AJOG 167 1513 1992 Retro. 237 primip failed VBAC compared to 1582 nullig with failed TOL. results- there were no sig. differences in maternal or neonatal morbid except for the presence of thin MSAF in primary CS.
Strong
(Phoenix, AZ)		 Amnioinfusion among women attempting VBAC OG 79 673 1992 901 attempting VBAC, 18 received Amnioinfusion with no untoward effects.
Troyer OB parameters affecting success in a TOL: designation of a scoring system AJOG 167 1099 1992 Chart review of 264 TOL, had success rate of 72.7%, , said that they had a scoring system but did not list in abstract.

1991
Author Title Journal vol pg yr Abstract
Beckley
(Birmingham, UK)		 Scar Rupture in VBAC: the role of uterine activity measurement BJOG 98 265 1991 12 VBAC with UR reviewed. Uterine activity patterns disc.
Farmer
(LAC/USC)		 Uterine Rupture during trial of labor after PCS AJOG 165 996 1991 137 uterine rut (119,395 del., 9% had prev. CS, 69% attempt VBAC, 79% successful, VBAC had UR rate of 0.8% with additional 0.7% had bloodless scar separation. The most common manifestation of UR is fetal brady.
Flamm External version after PCS AJOG 165 370 1991 Approx. 100,000 CS done in US for Breech, 56 pts. with HX. of PCS had ECV attempted with 82% success in turning-65% of these went on to have a vaginal del.. No serious mat or fetal comp. were assoc. with ECV
Flamm VBAC: Low risk, not no risk Cont OG 36 24 1991 1/3 of CS are repeat, incid. of ruptured uterus is <1%, 6 rules to lower incid. of UR= 1. be sure incis is LTCS, 2. insist on continuous EFM, 3. Intervene quickly for suspicious monitor findings, 4. don't rely on internal pressure cath (changes of UR subtle or non existent), 5. Be cautious with Pitocin (7 of 8 UR involved Pitocin), 6. follow ACOG guidelines.
Granja
(Maputo Mozambique)		 Management of labor following CS in a developing country Clin Exp OG 18 47 1991 17% CS rate in 1989, 179 PCS pts., 52% VBAC. no mat deaths, 5 stillborns and one early neo. death in study group (PNM less than overall hosp PNM).
Heddleston VBAC in a small hosp Mil Med 156 239 1991 30 month period, TOL was successful in 76% of pts with PCS
Iglesias Reducing CS rate in a rural community hosp. Can Med AJ 145 1459 - 64 1991 The overall CS rate decreased in a community hosp from 23% to 13% CS rate in pts approp for VBAC dropped from 93% to 36%.
Johnson TOL: a study of 110 pts Jclin Anes 3 216 1991 Studied whether epidural is unsafe for TOL. 110 pts attempting TOL offered epidural, 51/100 accepted. 67% overall were successful,. There were 2 complete uterine ruptures, neither had epidurals. Presentation was fetal distress rather than pain.
Jones
(Fitzsimons Army Med Center, Colo)		 Rupture of LTCS scars during TOL OG 77 815 1991 8 cases of UR occurring during period of 13 months at 5 hosp. Est incid. is 0.7% of planned TOL. Comp. include one neonatal death, 2 cases of severe neonatal asphyxia, 3 maternal bladder lac and one hyst.
Joseph
(Ochsner)		 VBAC: the impact of pt. resistance to a trial of labor AJOG 164 1441 1991 167 pts., 25% of pt. who were strongly encouraged to have VBAC had CS instead.
Kafkas
(Turkey)		 UR IJOG 34 41 - 4 1991 Retro, 41 cases from 1983-88 for an incid of 1 in 966 deliveries. 61% were in grandmultips, (there were no UR in primigravidas), 76% d/t CPD. Maternal mortality was 7.3% while fetal mortality was 83%. Midwife education, regular antenatal care and hospital deliveries are important factors in prevention.
Krishnamurthy The role of postnatal x-ray pelvimetry after CS in the management of subsequent delivery BJOG 98 716 1991 331 women had x ray pelvimetry after CS, 248 (75%) had inadequate pelvimetry and 83 (25%) were normal. 76 of the inadeq. pelvimetry attempted TOL with 51 delivering vaginally. All 3 UR occurred in pts with adeq. pelvis. Conc-practice of x ray pelvimetry should be abandoned.
Lomas Opinion leaders vs. audit and feedback to implement practice guidelines: del. after prev. CS. JAMA 265 2202 1991 Rand. control study, 76 MDs in 16 community hosp eval audit/feedback and local opinion leader education as methods of encouraging compliance with a guideline for VBAC. After 24 months, the TOL/VBAC rates in the audit/feedback gp were no different, but rates of VBAC were 46% and 85% higher respectively with MDs education by opinion leader and with opinion leaders. The overall CS rates were reduced only in the opinion leader education group. The use of opinion leaders improved quality of care.
Mock VBAC in a rural West African hospital IJOG 36 187 1991 220 pts with hx of PCS, 66% had successful VBAC of those with TOL. Success correlated directly with the number of prior vaginal deliveries and inversely with the number of PCS. Maternal and fetal outcomes did not differ with TOL or no TOL.
Myers
(Mt Sinai, Chicago)		 A successful program to reduce CS rates: friendly persuasion QRB Qual Rev Bull 17 162 1991 F/u on program to reduce CS rates
Pitkin Once a CS? OG 77 939 1991 Editorial, the women with a uterine scar are not low risk, they require caution and thought in arriving at a plan of management
Pridjian
(U of Chicago)		 CS: changing the trends OG 77 195 1991 U of Chic, VBAC intro in 1982., has helped stabilize the overall CS rate in the face of a rising primary CS rate.
Rachagan
(Malaya)		 Rupture of the pregnant uterus -- a 21 year review Aus NZ JOG 31 37 1991 Review of UR in Malaysia.
Rosen
(Sloan Hosp for Women)		 VBAC: a meta- analysis of morbidity and mortality OG 77 465 1991 Included 31 studies with total of 11,417 TOL . Intended route (VBAC vs. CS) made no difference about UR or UD. Use of Pitocin, presence of recurrent indication or presence of unknown scar were not assoc. with UR or UD. VBAC had decreased maternal febrile mortality, but there was no difference in perinatal mortality.
Schiotz
(Norway)		 Rupt. of the uterus in labor An unusual case followed by US Arch GO 249 43 1991 Case report, VBAC with UR Dx by US postpartum with a large amt. of fluid in pelvis, confirmed by findings of fetal cells in fluid. Managed expectantly.
Scott
(U of Utah)		 Mandatory TOL after CS delivery: an alternative viewpoint OG 77 811 1991 12 women experienced major UR during TOL (11 prev. LTCS, 1 LVCS), 2 required hyst, one had serious post-operative complications.
Spellacy
(U of South Florida)		 VBAC: a reward/penalty system for national implementation OG 78 316 1991 Proposes incentive system that MD is paid more for vaginal birth and pt. assumes financial responsibility for hosp costs beyond a vag. del.
Stafford The impact of nonclinical factors on repeat CS JAMA 265 59 - 63 1991  
Taffel 1989 US CS rate steadies, VBAC rate rises to nearly 1 in 5 Birth 18 73 1991 1989 CS rate was 23.8% (was 24.7%, 24.4%, 24.1% the three prev. years.). The 1989 primary rate of 17.1% was not different than the three previous years. VBAC rate did change remarkably from 12.6% in 1988 to 18.5% in 1989.
Thorp Epidural Analgesia and Cesarean Section for Dystocia: Risk Factors in Nulliparas AJ Peri 8 402 - 410 1991 Labor progress with and without epidurals at different dilations and stations. Epidural women were more likely to have oxytocin and cesareans for dystocia.
Thurnau
(U of Okla)		 The fetal- pelvic index: a method of identifying fetal- pelvic disproportion in women attempting VBAC AJOG 165 353 1991 Used fetal head and abd circ with the maternal pelvic inlet and midpelvic circ (x-ray), compared with Colcher-Sussman x-ray pelvimetry and US predict EFW >4000 gms. 52 pts. had a neg. pelvic index- 47 had VBAC, 5 had CS, all 13 with positive index failed to progress in labor. Neither of the other two tests proved accurate.
van Roosmalen VBAC in rural Tanzania IJOG 34 211 1991 137 pts with PCS and had TOL, 87 successful, 6.7% had scar rupture

1990
Author Title Journal vol pg yr Abstract
Bider
(Israel)		 The use of Pitocin after a PCS -- a review and report on a series Arch GO 247 15 1990 Review of the lit and summary of their experience.
Chazotte
(A. Einstein, NY)		 Labor patterns in women with PCS OG 75 350 1990 Case control study on patterns of labor progress and incid. of dysfunctional labor in pts. with PCS. 68 pts. had matched controls. Labor disorders were present most freq. in the PCS gp with no prior vag. del. (42%) versus 14% with prior vag. del.
Chazotte
(A. Einstein, NY)		 Catastrophic complications of previous CS AJOG 163 738 1990 711 pts., 2.4% had extremely serious comp. 9 uterine rupture (5 in labor), 2 cases of previa, 5 of accreta. The nature and freq. of comp. emphasize potential seriousness.
Coltart
(Queen Charlotte's Maternity Hosp.)		 Outcome of second preg. after previous LTCS BJOG 97 1140 1990 195 pts. attempting VBAC, 79% delivered. Pts. who went into labor spon had sig. better chance of del.
Egwuatu
(Nigeria)		 Vag. del. in Nigerian women after PCS IJGO 32 1 1990 154 pts. with PCS, repeat CS done in 33.8%, 102 attempted VBAC, 71.6% successful. UR occurred in 5 (4.9%) with the loss of 2 babies, there was no maternal loss.
el Gammal Breech vaginal delivery after one CS: a retro. study IJOG 33 99 1990 Retro., 86 pts. with PCS and breech, 33 given a chance at VBAC (abstract truncated).
Flamm Birth After Cesarean       1990 Classic text on VBAC. pub: Prentice-Hall.
Flamm
(Kaiser)		 VBAC: results of a 5 year multicenter collaborative study OG 76 750 1990 5733 attempt VBAC, 75% successful. There were no maternal deaths, perinatal mortality was not sig. different from the general OB population.
Goldman
(U of Montreal)		 Effects of patients physician and hospital characteristics on the likelihood of VBAC CMAJ 143 1017 1990 Case control, 400 VBAC comp. with 1600 elect repeat CS, those successful were likely to be taken care of by high risk spec and at tertiary facilities (perception if VBAC is a high risk proposition).
Hansel VBAC after 2 or more CS: a 5 year experience Birth 17 146 1990 Retro., 170 pts. with 2 or more prev. CS, 35 had TOL, 77% had successful vag. del. No increase in maternal or fetal morbid or mortality was assoc. with labor.
Harlass
(Madigan Army Medical Center, Tacoma, WA)		 The duration of labor in primip undergoing VBAC OG 75 45 1990 Retro., 73 successful VBAC studied, Conc: primips attempting VBAC have a similar labor to that of a Primig.
Kirk
(Oregon)		 VBAC or repeat CS: medical risks or social realities AJOG 162 1398 1990 160 pts., 1/2 indicated themselves as primary decision maker.
Klungsoyr
(Ethiopia)		 UR Rx with suture Acta OG Scand 69 93 - 4 1990 1983-85, 63 pts in labor with UR were Rx mainly with suture of the uterus. None of those operated on died, recommend suturing as the Rx. of choice.
Lazarov Rupture of the uterine cicatrix in VBAC Akush Ginekol 29 15 1990 740 deliveries after one or more PCS, 420 retrospective and 320 prospective. 59% underwent repeat CS, 304 delivered vaginally with 4 uterine ruptures.
McClain The making of a medical tradition: VBAC Soc Sci Med 31 203 1990 Interviews with 100 women showed that the choice of CS versus VBAC was largely influenced by respondent's interactions with physicians and their remembrance of the previous CS, their ethnic background, etc.
Meehan
(Univ. College Galway, Ireland)		 True rupture/scar dehiscence in VBAC IJGO 31 249 1990 1498 pts. with hx. of prev. CS, 844 attempted VBAC while the remaining 654 had repeats as they had 2 prev. CS. 8 true ruptures and 22 scar dehiscence were found. Regional analgesia and Pitocin had no effect on rate of rupture. Rupture occurred most freq. in the initial trial of labor. There were 4 perinatal deaths assoc. with true rupture. 5 true ruptures were found in the TOL gp (1:169) with the loss of 3 babies. One further stillborn was in mother with classical scar before labor. 2 pts. had their rupture repaired and were del. by CS next preg. There were no maternal deaths in TOL gp, one in el. CS group.
Mor-Yosef Vaginal Deliver following one previous CS Asia Oc JOG 16 33 1990 Survey, 22,815 deliveries. The overall CS rate was 9.6%. 55% of pts with one PCS delivered vaginally. Rupture of the uterus occurred in 1.2% with PCS versus 0.03% with intact uterus. There were no fetal or maternal mortality.
Phelan UR Clin OG 33 432 - 7 1990 UR is a sudden, unforeseeable event that carries a high rate of maternal and perinatal mortality. When Dx. is suspected, prompt surgical intervention with an experienced pelvic surgeon and blood product replacement should be considered. Repair is a reasonable consideration. In those pts with repair, early delivery after fetal maturity would appear prudent. Fetal distress is the most common sign of UR and freq. precedes any other clinical manifestation.
Rosen
(Sloan Hosp)		 VBAC: a meta- analysis of indicators for success. OG 76 865 1990 Antic a greater than 50% success rate for del.
Sakala Epidural analgesia. Effect on the likelihood of a successful TOL after PCS JRM 35 886 - 90 1990  
Sakala Oxytocin use after PCS: why a higher rate of failed TOL? OG 75 356 1990 Retro., 1984-1986 237 pts. with HX. of PCS had TOL of which 73 received Pitocin which were compared to 164 who did not. Success was 68% in Pitocin gp and 89% in no Pitocin gp.
Sanchez - Ramos Reducing CS at a teaching Hosp AJOG 163 1081 1990 Univ. Med Cent Jacksonville FL, department wide effort to reduce CS rate began in 1987. Overall rate declined from 28% in 1986 to 11% in 1989. Decreasing # of repeat CS played a major role. In 1986 32% of PCS had a TOL by 1989 84% had TOL (in 1986 65% successful, 1989 83% were successful) Changes in eval and management of dystocia and fetal distress played a role (14% to 4%) Reduction accomplished without compromising neonatal outcomes.

ERCS=Elective repeat Cesarean Section, PCS=Prior Cesarean Section, TOL=Trial Of Labor, UR=Uterine Rupture, UD=Uterine Dehiscence, conc.=conclusion, ECV=External Cephalic Version, LTCS=Low Transverse Cesarean Section, LVCS=Low Vertical Cesarean Section, EFM=Electronic Fetal Monitoring, PNM=Peri-Natal Mortality, CPD=Cephalo-Pelvic Disproportion

We have honestly attempted to record everything accurately, however, please refer to original article for any major decisions pertaining to patient care.

Keywords for search:Vaginal Birth After CS, Cesarean Section, Uterine Rupture, Trial of Labor

Philip J. Rosenow, M.D.
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last revised: 2/21/05