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Does the ratio of membrane rupture to labor duration predict maternal morbidity among women with a successful VBAC
Abstract Number: F-43
Abstract Type: Original Research
Objective: Prolonged labor course has been associated with adverse outcomes in women having a successful vaginal birth after cesarean (VBAC). However, the influence of rupture of membrane (ROM) duration on maternal morbidity is poorly understood. We hypothesized that the ratio of ROM: labor duration predicts maternal morbidity among VBAC cases.
Study design: Using the MFMU Cesarean registry, our cohort comprised of women with singleton, term pregnancies (≥37 weeks of gestation) who had a successful VBAC. Maternal morbidity was defined by at least one of the following: sepsis, chorioamnionitis, postpartum endometritis, intensive care admission, postpartum transfusion, uterine rupture, or maternal death. The ratio between ROM duration to labor duration was categorized into quartiles (<0.24; 0.24-0.29; 0.50-0.94; ≥0.95). Variables associated with maternal morbidity in bivariate analysis (P<0.1) were included in a stepwise multiple logistic regression model.
Results: Among 9,392 women with successful VBAC, 515 (5.5%) experienced maternal morbidity. Women with ratios in the upper quartiles (3rd and 4th) were at increased risk of morbidity (Table). Variables independently related to maternal morbidity were African American, Asian or Hispanic race/ethnicity; public insurance; BMI ≥25 and regional anesthesia.
Conclusion: Among women having a VBAC, a ratio of ROM duration to labor duration ≥0.5 was associated with the highest odds for maternal adverse outcome. Prospective studies are needed to assess the value of this ratio in predicting maternal morbidity in women attempting VBAC.