General obstetrics and gynecology: obstetrics
Trial of labor in patients with a previous cesarean section: does maternal age influence the outcome?

https://doi.org/10.1016/j.ajog.2003.09.055Get rights and content

Abstract

Objective

This study was undertaken to evaluate the effect of maternal age on the rate of vaginal delivery and the rate of uterine rupture in patients undergoing a trial of labor (TOL) after a prior cesarean delivery.

Study design

A cohort study of all women with a live singleton fetus undergoing a TOL after a previous low-transverse cesarean delivery was performed between 1988 and 2002 in a tertiary care center. Patients were divided into 3 groups according to maternal age: less than 30 years old, 30 to 34 years old, and 35 years or older. Women with no prior vaginal delivery and with at least 1 prior vaginal delivery were analyzed separately. The rate of vaginal delivery and the rate of symptomatic uterine rupture were calculated. Multivariate logistic regression analyses were performed to adjust for potential confounding variables.

Results

Of the 2493 patients who met the study criteria, there were 1750 women without a prior vaginal delivery (659, 721, and 370, respectively) and 743 women with a prior vaginal delivery (199, 327, and 217, respectively). The rate of uterine rupture was comparable between the groups (2.0%, 1.1%, 1.4%, P = .404 and 0%, 0.3%, 0.9%, P = .312). Successful vaginal delivery was inversely related to maternal age (71.9%, 70.7%, 65.1%, P = .063, and 91.5%, 91.1%, 82.9%, P = .005). After adjusting for confounding variables, maternal age equal to or greater than 35 years old was associated with a lower rate of successful vaginal delivery in patients without prior vaginal delivery (odds ratio [OR] 0.73, 95% CI: 0.56-0.94), and in patients with a prior vaginal delivery (OR: 0.47, 95% CI: 0.29-0.74).

Conclusion

Patients who are 35 years or older are more prone to have a failed TOL after a prior cesarean delivery.

Section snippets

Material and methods

The study was conducted at Ste-Justine Hospital, a tertiary care hospital, which has an attending obstetrician and attending anesthesiologist present in labor and delivery at all times. All women with a prior low-transverse cesarean section, who delivered infants more than 23 weeks' gestation with birth weights of 500 g or more and who underwent a TOL between December 1988 and December 2002, were analyzed. Three independent databases were used: Perinatal Database of Ste-Justine Hospital, the

Results

During the 14-year-study period, 2493 patients had a history of a previous low-transverse cesarean section and met inclusion criteria, 1750 patients had no prior vaginal delivery, and 743 patients had at least 1 prior vaginal delivery. Of the 1750 patients with no history of a prior vaginal delivery, there were 659 (37.6%) patients under 30 years old, 721 (41.3%) patients between 30 and 34 years old, and 370 (21.1%) patients 35 years or older. Of the 743 patients with at least 1 prior vaginal

Comment

In our study, we found that advanced maternal age was associated with a higher rate of failed TOL in patients with a prior cesarean section. In addition, older patients were more likely to have had a prior successful vaginal delivery. The rate of successful VBAC in these patients is more than 80%. However, we found no association between maternal age and the risk of uterine rupture. Furthermore, we found no association between the maternal age at the time of the prior cesarean section and the

References (30)

Cited by (49)

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This study was conducted at the Hôpital Ste-Justine in Montreal, Quebec, Canada.

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