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CC BY-NC-ND 4.0 · AJP Rep 2020; 10(02): e148-e154
DOI: 10.1055/s-0040-1708493
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Applying a Prediction Model for Vaginal Birth after Cesarean to a Latina Inner-City Population

Michelle T. Nguyen 
1   Department of Obstetrics and Gynecology, Adventist Health White Memorial Medical Center, Los Angeles, California
,
Teodocia Maria Hayes-Bautista
2   Department of Graduate Medical Education, Adventist Health White Memorial Medical Center, Los Angeles, California
,
Paul Hsu
3   Department of Epidemiology, UCLA School of Public Health, Los Angeles, California
,
Christina Bragg
1   Department of Obstetrics and Gynecology, Adventist Health White Memorial Medical Center, Los Angeles, California
,
Irving Chopin
4   Department of Organizational Performance, Adventist Health White Memorial Medical Center, Los Angeles, California
,
Kathryn J. Shaw
5   Department of Maternal-Fetal Medicine, Adventist Health White Memorial Medical Center, Los Angeles, California
› Author Affiliations Funding The authors have no sources of funding, financial interests, or other relationships to disclose.
Further Information

Publication History

03 October 2019

19 January 2020

Publication Date:
15 April 2020 (online)

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Abstract

Background The Maternal–Fetal Medicine Units (MFMU) Network developed a prediction model for calculating the likelihood of successful vaginal birth after cesarean (VBAC) in patients undergoing a trial of labor after cesarean (TOLAC). In this prediction model, Latina ethnicity is considered a negative predictive factor for successful VBAC. Subsequent studies have found mixed results regarding VBAC success in Latina ethnicity.

Objective Our aim was to compare the predicted chance of successful VBAC (as calculated using the MFMU prediction model) to actual TOLAC outcomes in a large Latina sample.

Study Design We performed a retrospective cohort study of Latinas who underwent TOLAC at our institution from January 1, 2013 to December 31, 2016. The MFMU prediction model was used to calculate each participant's predicted success, and the participants were then categorized into three groups based on predicted success: low (<35%), moderate (35–65%), and high (>65%). The predicted success rates versus actual outcomes were compared among the three groups.

Results A total of 567 Latinas met inclusion criteria. Successful VBAC occurred in 476 patients (84%). VBAC was achieved in 65.3% of the low predicted success group, 84.4% of the moderate predicted success group, and 91.7% of the predicted high success group. Actual VBAC success rates exceeded the predicted success rates for the low and moderate groups.

Conclusion Our results question whether Latina ethnicity should continue to be considered a negative predictive factor for VBAC success. Our results also suggest that Latinas with a low predicted VBAC success should not necessarily be discouraged from attempting TOLAC.

Keywords

trial of labor after cesarean - vaginal birth after cesarean - hispanic - Latina - ethnicity

Note

The study findings were presented in poster format at the 85th annual meeting of Pacific Coast Obstetrical and Gynecological Society, September 26–30, 2018, Coeur d'Alene, Idaho.


 

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