This chapter should be cited as follows: Under review - Update due 2018

Labor and delivery

Vaginal Birth After Cesarean: Addendum

Bruce L. Flamm, MD
Clinical Professor of Obstetrics and Gynecology, University of California, Irvine Medical Center; Research Chair, Kaiser Permanente, Riverside, California


A recent retrospective review of hospital discharge data found what appeared to be a marked increase in uterine rupture rates when prostaglandins were used for cervical ripening in vaginal birth after cesarean (VBAC) patients.1 However, the study had serious limitations that were appropriately acknowledged by its authors and subsequently reviewed in a published critique.2 In spite of the study’s limitations, the American College of Obstetrics and Gynecology (ACOG) responded by publishing a Committee Opinion stating that, “The purpose of this document is to discourage the use of prostaglandins for cervical ripening or the induction of labor in women attempting VBAC.3 This opinion will no doubt be controversial because both a large multicenter study and a review of many smaller studies did not find any increased risk with prostaglandin use in VBAC patients.4,5



Lydon-Rochelle M, Holt V, Easterling T: Risk of uterine rupture during labor among women with a prior cesarean delivery. N Engl J Med 345:3, 2001



Flamm B: Vaginal birth after cesarean and the NEJM: A strange controversy. Birth 28:276, 2001



ACOG Committee on Obstetric Practice: Induction of labor for vaginal birth after cesarean delivery: ACOG Committee Opinion Number 271. Obstet Gynecol 99:679, 2002



Phelan J: VBAC: Time to reconsider? OBG Manage 11:62, 1996



Flamm B, Anton D, Goings J, et al: Prostaglandin E2 for cervical ripening: A multicenter study of patients with prior cesarean delivery. Am J. Perinatol 14:157, 1997

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