White’s Classification of Maternal Diabetes and Vaginal Birth After Cesarean Delivery Success in Women Undergoing a Trial of Labor

Authors:
  • MLMark B. Landon
    Mark B. Landon
  • YLYinglei Lai
    Yinglei Lai
  • CSCatherine Y. Spong
    Catherine Y. Spong
  • DRDwight J. Rouse
    Dwight J. Rouse
  • KLKenneth J. Leveno
    Kenneth J. Leveno
  • HSHyagriv N. Simhan
    Hyagriv N. Simhan
  • RWRonald J. Wapner
    Ronald J. Wapner
  • YSYoram Sorokin
    Yoram Sorokin
  • MMMenachem Miodovnik
    Menachem Miodovnik
  • MCMarshall Carpenter
    Marshall Carpenter
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Abstract
OBJECTIVE: To estimate the rate of vaginal birth after cesarean delivery (VBAC) success in diabetic women based on White’s Classification. METHODS: This is a secondary analysis of an observational study conducted at 19 medical centers of women attempting VBAC. Diabetic women with singleton gestations, one prior cesarean delivery, and cephalic presentation who underwent a trial of labor were included. Vaginal birth after cesarean delivery success rates and maternal and neonatal complications were compared based on White’s Classification. RESULTS: Of 11,856 women who underwent trial of labor, 624 met all study criteria (class A1, 356; A2, 169; B, 70; C, 21; D/R/F, 8). Vaginal birth after cesarean delivery success in each group was: A1, 68.5% (95% confidence interval [CI] 63.4–73.3%); A2, 55% (95% CI 47.2–62.7%); B, 70% (95% CI 57.9–80.4%); C, 47.6% (95% CI 25.7–70.2%); and D/F/R, 12.5% (95% CI 0.3–52.7%). Maternal and neonatal complications were rare and not found to be different among groups. CONCLUSION: Our study provides estimates for VBAC success based on White’s classification and indicates a relatively low rate of perinatal complications after VBAC attempt for diabetic women. LEVEL OF EVIDENCE: III

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