Deciding on route of delivery for obese women with a prior cesarean delivery

OBJECTIVES: This study was undertaken to estimate the vaginal birth after cesarean (VBAC) success rate, compare rates of infections in women attempting VBAC and those undergoing planned repeat cesarean, and compare the cost of these two plans of care for obese women. STUDY DESIGN: We performed a historical cohort analysis of singleton deliveries at ≥36 weeksʹ gestation in women with a body mass index 40 or greater and one prior cesarean delivery. Outcomes included rates of VBAC success and puerperal infections and mean cost of care. RESULTS: The cohort consisted of 122 mother-infant pairs, 61 each in the VBAC and cesarean groups. In the VBAC group, 57% (95% CI 45-70) of women were delivered vaginally. The VBAC group had higher rates of chorioamnionitis (13.1% vs 1.6%, P = .02), endometritis (6.6% vs 0%, P = .06), and composite puerperal infection (24.6% vs 8.2%, P = .01). Mean cost of care was similar for mothers ($4439 vs $4427, P = .95), infants ($1241 vs $1422, P = .49), and mother-infant pairs ($5680 vs $5851, P = .64). CONCLUSION: Compared with planned cesarean delivery, VBAC trials in obese women are three times as likely to be complicated by infection and do not result in reduced costs.