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VBAC attempts, failures linked to maternal age.(Obstetrics)
LOS ANGELES -- Older women are less likely to attempt vaginal birth after cesarean delivery and more likely to fail when they do, Sindhu K. Srinivas, M.D., said at the annual meeting of the Society for Gynecologic Investigation.
Dr. Srinivas of the University of Pennsylvania, Philadelphia, presented a retrospective study of 25,005 women who were offered the option of vaginal birth after cesarean (VBAC) delivery at 17 community and university hospitals from 1996 to 2000. While 13,706 women (55%) attempted VBAC, 11,299 (45%) had an elective repeat cesarean section.
"We found as women got older, they attempted [VBAC] much less frequently than other women, but they also failed more," Dr. Srinivas said. "Biologically why that is the case, we are not quite sure."
Maternal age did not appear to be associated with risk of complications such as uterine rupture, bowel and bladder injury, blood transfusion, sepsis, and neonatal death. VBAC-related complication rates remained relatively constant in all age groups studied by Dr. Srinivas and her colleagues.
The youngest patients, 922 women ages 15 to 20 years, served as a reference group. A majority of these women--699--chose VBAC.
The largest cohort included 17,415 women, ages 21 to 34 years, 9,801 of whom elected VBAC. Compared with the youngest women, those in this group were about half as likely to attempt VBAC (adjusted odds ratio 0.46) and somewhat more likely to have a failed VBAC (adjusted odds ratio 1.74).
Among 5,574 women ages 35 to 39 years, 2,710 chose VBAC. The likelihood of a woman in this age group electing VBAC was about a third that of the youngest mothers (adjusted ...
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