An Observational Study of Cesarean Section and Vaginal Birth after Cesarean Section

This study, also known as the Cesarean Registry, was a prospective four-year observational study of all women with a singleton gestation and a prior cesarean delivery at 19 academic medical centers. Maternal and perinatal outcomes were compared between women who underwent a trial of labor and women who had an elective repeated cesarean delivery without labor. The primary objective was to determine the efficacy and safety of trial of labor in this population.

The primary analysis concluded that a trial of labor by women with a history of cesarean delivery is associated with an increased risk of adverse perinatal outcomes and a higher rate of maternal adverse events, as compared with elective repeated cesarean delivery. The magnitude of these risks is small; however, this information is important for women and health care providers who are making choices about the type of delivery.

The data released in DASH contains 70,411 women and 73,257 infants. Eight centers participated throughout the four years while eleven participated for two years. Demographic data, details of the obstetrical history, and information about intrapartum and postpartum events were recorded. Neonatal data were collected up to 120 days after delivery or at the time of hospital discharge, including the clinical course for infants admitted to the NICU. Separate data-collection forms were completed for maternal or infant complications.