Structured Abstract

Contents

• Preface
• Acknowledgments
• Executive Summary
  • Introduction
  • Methods
  • Results
  • Discussion
• 1. Introduction
  • Structure of Report and Key Questions
  • Introduction
  • Background
• 2. Methods
  • Topic Development
  • Literature Search and Strategy
  • Inclusion and Exclusion Criteria
  • Data Extraction and Synthesis
  • Size of Literature
• 3. Results
  • Among women who attempt a trial of labor after prior cesarean delivery, what is the vaginal delivery rate and the factors that influence it?
  • What are the short- and long-term benefits and harms to the mother of attempting trial of labor after prior cesarean versus elective repeat cesarean delivery, and what factors influence benefits and harms?
  • What are the short-and long-term benefits and harms to the baby of maternal attempt at trial of labor after prior cesarean versus elective repeat cesarean delivery, and what factors influence benefits and harms?
• 4. Discussion
  • What are the critical gaps in the evidence for decisionmaking, and what are the priority investigations needed to address these gaps?
• References
• Abbreviations and Acronyms
• Appendixes
  • Appendix A Technical Expert Panel Members
  • Appendix B Expert Reviewers
  • Appendix C Search Strategies
  • Appendix D List of Developed Countries
  • Appendix E Inclusion and Exclusion Criteria
  • Appendix F Excluded Studies List
  • Appendix G List of Citations From the Maternal-Fetal Medicine Units Network Cohort
  • Appendix H Quality Rating Criteria
  • Appendix I Individual Quality Rating Tables
  • Appendix J Strength of Evidence Table
  • Appendix K Detailed Evaluation of Predictors of Trial of Labor and Vaginal Birth After Cesarean
  • Appendix L Detailed Evaluation of Vaginal Birth After Cesarean Rates
  • Appendix M Induction of Labor Additional Figures
  • Appendix N Detailed Evaluation of Screening Tools for Predicting Vaginal Birth After Cesarean
  • Appendix O Detailed Maternal Mortality Table
  • Appendix P Predictive Tools of Uterine Rupture Table
  • Appendix Q Detailed Transfusion/Hemorrhage Table
  • Appendix R Detailed Infection Table
  • Appendix S Detailed Hospital Stay Table

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.¹ Contract No. 290-2007-10057-I. Prepared by: Oregon Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon.

Suggested citation:

Guise J-M, Eden K, Emeis C, Denman MA, Marshall N, Fu R, Janik R, Nygren P, Walker M, McDonagh M. Vaginal Birth After Cesarean: New Insights. Evidence Report/Technology Assessment No.191. (Prepared by the Oregon Health & Science University Evidence-based Practice Center under Contract No. 290-2007-10057-I). AHRQ Publication No. 10-E003. Rockville, MD: Agency for Healthcare Research and Quality. March 2010.

This information is based on research conducted by the Oregon Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2007-10057-I). The findings and conclusions in this document are those of the authors, who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

The information in this report is intended to help clinicians, employers, policymakers, and other make informed decisions about the provision of health care services. This report is intended as a reference and not as a substitute for clinical judgment.

This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

No investigators have any affiliations or financial involvement (e.g., employment, consultancies, honoraria, stock options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in this report.

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