Repeat Elective Cesarean Favored Over VBAC for Obese Patients.

HOT SPRINGS, VA. -- Maternal outcomes are better when obese women undergo elective repeat cesarean section instead of a trial of labor, results of a retrospective study suggest.

The odds of having a failed trial of labor--and the risks associated with a subsequent C-section--far outweigh the downsides of having an elective repeat cesarean section, Dr. Suneet P. Chauhan reported at the annual meeting of the South Atlantic Association of Obstetricians and Gynecologists.

In a retrospective study of women who weighed more than 300 pounds at their first prenatal visit, Dr. Chauhan, director of maternal-fetal medicine at Spartanburg (S.C.) Regional Medical Center and his colleagues, compared the outcomes of 30 women who attempted vaginal birth after cesarean section (VBAC) with those of 39 women who opted to undergo an elective repeat cesarean section.

All patients had singleton gestations and were managed at the University of Mississippi, Jackson, from June 1998 to June 2000.

The VBAC success rate was only 13%, and more than half of the women who underwent a trial of labor had infectious complications.

By contrast, the same hospital had a VBAC success rate of 68% for its overall population. Nationwide, VBAC success rates range from 60% to 80%, according to an American College of Obstetricians and Gynecologists practice bulletin published in 1999.

In general, among patients with only one prior low transverse cesarean incision, the costs of attempting and failing a trial of labor and the risks in terms of maternal morbidity and mortality are worth it as long as the VBAC success rate is at least 40% (Obstet. Gynecol. 95[5]:745-51, 2000).