Do They Stand a Chance? Vaginal Birth after Cesarean Section in Adolescents Compared to Adult Women

• Published in: Journal of pediatric & adolescent gynecology Vol. 28; no. 4; pp. 219 - 223
• Main Authors: Damle, Lauren F., MD, Wilson, Kathy, MD, Huang, Chun-Chih, PhD, Landy, Helain J., MD, Gomez-Lobo, Veronica, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-08-2015
• Subjects: Adolescent; Adolescent pregnancy; Adult; Body Mass Index; Cesarean Section - statistics & numerical data; Female; Gestational Age; Humans; Obstetrics and Gynecology; Pediatrics; Pregnancy; Retrospective Studies; Trial of Labor; Trial of labor after cesarean section; United States; Vaginal Birth after Cesarean - statistics & numerical data; Vaginal birth after cesarean section; Young Adult; Adolescent pregnancy; Vaginal birth after cesarean section; Trial of labor after cesarean section
• ISSN: 1083-3188; 1873-4332
• DOI: 10.1016/j.jpag.2014.07.010

Abstract Study Objective To determine the rate of elective repeat cesarean delivery (CD), vaginal birth after cesarean (VBAC) attempt, and VBAC success in adolescent mothers presenting for delivery of a second child after a prior CD compared to their adult counterparts. Design Retrospective cohort study analyzing data from the Consortium on Safe Labor Database which includes data for 228,668 deliveries from 2002 to 2008. Setting 19 hospitals within 12 institutions in the United States. Participants 10,791 women age ≤ 35 (428 adolescents, age ≤ 19 and 10,363 adults age 20-35) with history of prior CD presenting for delivery of a second child. Methods The database was accessed for information on patient characteristics, prenatal comorbidities, and delivery data. Rates of repeat CD, VBAC attempt, and VBAC success were calculated. Multiple logistic regression was applied to identify predictors of VBAC success. Results Adolescents had a lower overall repeat CD rate and higher VBAC attempt rate compared to adults (80.61% vs 85.32%, P  = .0072; 40.42% vs 30.09%, P  < .0001 respectively). VBAC success was similar between adolescents and adults (47.98% vs 48.78% P  = .8368). Delivery at a teaching hospital and greater gestational age were predictive of VBAC success. Gestational diabetes mellitus, induction of labor, and higher maternal body mass index were predictive of VBAC failure. Adolescence was not an independent predictor of VBAC outcome. Conclusions Adolescents are more likely to attempt VBAC and are likely to be as successful as their adult counterparts. Adolescents should be encouraged to attempt a trial of labor after prior CD when appropriate to lower the risks of lifelong maternal morbidity from numerous repeat CDs.