The MFMU cesarean registry: VBAC success and complication rates following one previous cesarean for multifetal gestation

Abstract

To determine the success and complication rates of women attempting a trial of labor (TOL) following one previous cesarean delivery (CD) for a multifetal gestation. This is a secondary analysis of a four-year prospective observational study (1999-2002) of all women with prior CD undergoing a TOL at 19 centers. Women with viable singleton pregnancies and one prior low transverse CD for twins or triplets were compared with those having a prior CD in a single gestation. Labor outcomes and perinatal complications were compared. A p-value < 0.05 was considered significant. Of 1,119 women with a prior CD for multifetal gestation, 646 women underwent a TOL (623 prior twins, 23 prior triplets). Compared with women who had one prior CD in a singleton pregnancy (N = 16,263), study women were more likely to have had at least one previous vaginal delivery (62.3% vs 49.2%, p < 0.0001) and were more likely to have a successful TOL in the current pregnancy (85.1% vs 73.4%, p < 0.0001). Study patients had no increased risk of atony, endometritis, uterine rupture or any other peripartum complications. Study patients who had a failed TOL were less likely to have had a previous vaginal delivery (35.8% vs 67.0%, p < 0.0001) or a vaginal delivery after their prior CD (15.1% vs 37.5%, p < 0.0001) but were not different in any demographic or peripartum findings than those study patients who had a successful vaginal delivery. Women with one previous CD for a multifetal gestation have a high likelihood of a successful TOL in subsequent pregnancies and are not at increased risk for peripartum complications.