A modified prediction model for VBAC, in a European population.

OBJECTIVE: The first aim of the study is to validate the Grobman's Nomogram on Italian population, and then to include other variables with the purpose to increase the accuracy of the Nomogram. METHODS: This is a multicenter study in which eligible subjects were pregnant women reaching term having one prior cesarean section (CS) and then choosing for a trial of labor. Multivariate logistic regression model have been performed, and then the predicted percentages of vaginal delivery (VD) success were divided into 10 groups and compared with the observed ones. RESULTS: Among 1161 women, 1100 were enrolled, of which 857 (77.9%) delivered vaginally. At the multivariate logistic regression, the variables predicting vaginal birth after cesarean (VBAC) in the validation were maternal age (p < 0.001), maternal body mass index (p = 0.007), having had a VD (p = 0.008) and recurring indication for CS (p < 0.001). By adding the two new variables in the proposed model, was reached the significance of "African ethnicity" (p = 0.037) and especially "years of education" (p = 0.032). CONCLUSIONS: The Grobman's Nomogram seems to be applicable to Italian population too, even if with less accuracy than in the US population. The addition of the level of maternal education increases the accuracy of the model, underlining the importance of the social context in the choice of VBAC.

Induction of labor in women that had a previous cesarean delivery.

OBJECTIVE: This study aims to evaluate factors that predict the likelihood of the success of induction of labor (IOL) in women that had a previous cesarean section (pCS). METHODS: Pregnant women with one pCS performed more than 18 months prior were included in this retrospective observational study. Of the 242 eligible women, 234 were enrolled; 120 (51.3%) of these women delivered vaginally (VD), with the remainder receiving a repeat CS. RESULTS: The main reasons for IOL were premature rupture of membranes (PROM) (37.1%) and post-date pregnancy (26.5%). Babies with a birth weight≥4000 g were more prevalent in women undergoing CS (21/114; 18.4%, p<0.02) and were associated with the failure of IOL. Uterine rupture during labor (1.3%) occurred in three cases. Having had a previous vaginal delivery (VD) (p=0.01), not being African (p=0.022), and receiving IOL for PROM (p=0.04) with a cervical Bishop score≥5 (p=0.015) significantly predicted the occurrence of a VD, with an 15% variance (p<0.001). An age>35 years appears to not affect the success of induction. CONCLUSIONS: A successful IOL should be expected in Caucasian women induced for PROM with a favorable Bishop score.

The pregnant uterus as a psycho-endocrine organ.

The pathogenesis of preterm birth (PTB) is largely unknown and the endocrine stress pathway is likely to participate in the mechanisms allowing onset of labor. However, the vast majority of the studies evaluating psychosocial distress denied an association with PTB. Uterine contractility rather than PTB seems associated with distress in pregnancy.