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Predictors of Neuraxial Block Utilization Among Women undergoing Successful Vaginal Birth after Cesarean
Abstract Number: F-11
Abstract Type: Original Research
Introduction: The use of neuraxial labor analgesia is encouraged by obstetric societies for women planning vaginal birth after cesarean delivery (VBAC).(1,2) However, among women who undergo successful VBAC, predictors of neuraxial block (NB) utilization are not well described.
Methods: We performed a secondary analysis from the MFMU Cesarean Registry (3) to identify women who underwent successful VBAC with or without NB (epidural, spinal or spinal-epidural). Using multivariate logistic regression, we identified predictors for NB based on demographic, obstetric and intrapartum characteristics.
Results: Our cohort comprised 10,375 women who underwent successful VBAC; 9438 (87.9%) received NB. Predictors for NB use are shown in the Table. Compared to women with spontaneous labor, women undergoing inductions or augmented labor were more likely to receive NB. Multiparous women (aOR=5.1) and women with preterm labor (aOR=0.44) had a decreased likelihood of receiving NB. We also observed evidence of racial/ethnic disparities in NB utilization in our cohort (Table), with Hispanic (aOR=0.23) and African-American (aOR=0.22) women having a lower likelihood of receiving NB compared to Caucasian women.
Conclusion: In our study, the rate of NB use among women who underwent successful VBAC was high. Although we could not account for all potential confounders (such as patient-level, physician-level, and hospital-level factors) for NB use in our analysis, our findings suggest that obstetric factors and race/ethnicity influence utilization of NB among women undergoing successful VBAC.
References: 1.ACOG Practice bulletin 115 Obstet Gynecol 2010;116:450-63. 2.RCOG Green Top Guideline No.45 Birth after previous caesarean birth https://www.rcog.org.uk/globalassets/documents/guidelines/gtg4511022011.pdf 3.Landon MB. Am J Obstet Gynecol 2005;193:1016-23.