This study was undertaken to determi ne the impact of ma-ternal obesity on success of a trial of labor(vaginal birth after cesarean sectionVBAC)after a single low transverse ce-sarean delivery.Individual charts of wom...This study was undertaken to determi ne the impact of ma-ternal obesity on success of a trial of labor(vaginal birth after cesarean sectionVBAC)after a single low transverse ce-sarean delivery.Individual charts of women with low transverse cesarean delivery in their first viable pregnancy who underwent a VBAC in their second v iable pregnancy at our urban tertiary care institution were reviewed.Maternal body mass index(BMI )was classified as underweight (<19.8kg /m 2 ),normal(19.8-24.9kg /m 2 ),over-weight (25-29.9kg /m 2 ),or obese(≥30kg /m 2 ).Clinical characteristics and labor outcomes were assessed.Factors potentially affecting VBAC success were analyzed by univariate analysis.Logistic re gressions were performed to determine the impact of maternal p regravid BMI on VBAC success after controlling for c onfounding factors.Of 510women attempting a trial of labor,337(66%)were successful and 173(34%)failed VBAC.Decreased VBAC success was seen in obese(54.6%)but not over-weight (65.5%)women compared with women of normal BMI (70.5%),P =.003and.36,respectively.Un-derweight women had more VBAC success than women of normalBMI (84.7%vs 70.5%,P =.04).Controlling for other factors,the association b etween increasing pre-gravid BMI and BMI ≥30kg /m 2 with decreased VBAC success persisted,P =.03and.006,r espectively.Nor-mal BMI women who became overweight before the second pregnancy had decreased VBAC success compared with those whose BMI remained normal(56.6%vs 74.2%,P =.006).However,overweight women who decreased their BMI to normal before the second pregnancy did not significantly improve VBAC success(64.0%vs 58.4%,P =.67).Increasing pregravid BMI and weigh t gain be-tween pregnancies reduce VBAC succe ss after a single low transverse cesarean delivery.展开更多
文摘This study was undertaken to determi ne the impact of ma-ternal obesity on success of a trial of labor(vaginal birth after cesarean sectionVBAC)after a single low transverse ce-sarean delivery.Individual charts of women with low transverse cesarean delivery in their first viable pregnancy who underwent a VBAC in their second v iable pregnancy at our urban tertiary care institution were reviewed.Maternal body mass index(BMI )was classified as underweight (<19.8kg /m 2 ),normal(19.8-24.9kg /m 2 ),over-weight (25-29.9kg /m 2 ),or obese(≥30kg /m 2 ).Clinical characteristics and labor outcomes were assessed.Factors potentially affecting VBAC success were analyzed by univariate analysis.Logistic re gressions were performed to determine the impact of maternal p regravid BMI on VBAC success after controlling for c onfounding factors.Of 510women attempting a trial of labor,337(66%)were successful and 173(34%)failed VBAC.Decreased VBAC success was seen in obese(54.6%)but not over-weight (65.5%)women compared with women of normal BMI (70.5%),P =.003and.36,respectively.Un-derweight women had more VBAC success than women of normalBMI (84.7%vs 70.5%,P =.04).Controlling for other factors,the association b etween increasing pre-gravid BMI and BMI ≥30kg /m 2 with decreased VBAC success persisted,P =.03and.006,r espectively.Nor-mal BMI women who became overweight before the second pregnancy had decreased VBAC success compared with those whose BMI remained normal(56.6%vs 74.2%,P =.006).However,overweight women who decreased their BMI to normal before the second pregnancy did not significantly improve VBAC success(64.0%vs 58.4%,P =.67).Increasing pregravid BMI and weigh t gain be-tween pregnancies reduce VBAC succe ss after a single low transverse cesarean delivery.
