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Vaginal birth after cesarean in the diabetic gravida
S C Blackwell1, S S Hassan, H M Wolfe
1Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Hutzel Hospital, 4707 St. Antoine Boulevard, Detroit, MI 48201, USA. mfmboy@aol.com
Objective:
To compare the delivery outcomes in term diabetic patients without a prior cesarean delivery to those attempting vaginal birth after cesarean (VBAC).
Study Design:
A retrospective chart review study was performed of singleton pregnancies complicated by class A-2-R diabetes who delivered at > or = 37 weeks from 1991 to 1997. Exclusion criteria were prior classical or low vertical cesarean, more than one prior cesarean delivery, fetal structural defects or any contraindications to labor. Outcome measures were compared for patients without prior cesarean (group 1) to those with a VBAC attempt (group 2).
Results:
One hundred fifty-nine patients, 127 patients without a prior cesarean delivery and 32 patients with a VBAC attempt, met all the study criteria. The cesarean delivery rate was 26.3% (34/127) in group 1 and 56.3% (18/32) in group 2 (VBAC success rate, 43.7%). There were no cases of uterine rupture. There were no differences in the frequency of endometritis rates or neonatal intensive care unit admission, whether vaginal or cesarean delivery occurred.
Conclusion:
VBAC success rates appeared to be lower for diabetic gravidas as compared to those for nondiabetic women reported in the literature. Although maternal and neonatal complication rates were low, further studies are necessary to determine the safety of VBAC in this population.