RESUMO
OBJECTIVE: To estimate whether maternal race/ethnicity is independently associated with successful vaginal birth after cesarean delivery (VBAC). STUDY DESIGN: A retrospective cohort study from January 1, 1997 to July 30, 2002 of women with singleton pregnancies and a previous cesarean delivery. The odds ratio (OR) for successful VBAC as a function of ethnicity was corrected for age >35 years, parity, weight gain, diabetes mellitus, hospital site, prenatal care provider, gestational age, induction, labor augmentation, epidural analgesia, and birth weight >4000 g. RESULTS: Among 54 146 births, 8030 (14.8%) occurred in women with previous cesarean deliveries. The trials of labor rates were similar among Caucasian (46.6%), Hispanic (45.4%), and African American (46.0%) women. However, there was a significant difference among ethnic groups for VBAC success rates (79.3% vs. 79.3% vs. 70.0%, respectively). When compared to Caucasian women, the adjusted OR for VBAC success was 0.37 (95% confidence interval (CI) 0.27-0.50) for African American women and 0.63 (95% CI 0.51-0.79) for Hispanic women. CONCLUSION: African American and Hispanic women are significantly less likely than Caucasian women to achieve successful VBAC.
Assuntos
Negro ou Afro-Americano , Hispânico ou Latino , Nascimento Vaginal Após Cesárea , População Branca , Adulto , Peso ao Nascer , Recesariana/estatística & dados numéricos , Estudos de Coortes , Intervalos de Confiança , Feminino , Humanos , Modelos Logísticos , Razão de Chances , Gravidez , Resultado da Gravidez/etnologia , Estudos Retrospectivos , Fatores de Risco , Prova de Trabalho de Parto , Ruptura Uterina/etnologia , Ruptura Uterina/etiologia , Nascimento Vaginal Após Cesárea/efeitos adversosRESUMO
OBJECTIVE: This study was undertaken to assess whether racial differences in the risk of cesarean delivery result from differing practices of their caregivers or the hospitals at which they deliver. STUDY DESIGN: A retrospective cohort study was performed using the Perinatal Database of the Memorial Health Care System. Logistic regression was used to estimate the risk of primary cesarean delivery among patients eligible for labor. The contribution of hospital and physician level cluster correlation was evaluated using fixed and random effects regression models. RESULTS: Compared with white patients, black and Hispanic patients were 75% and 22% more likely to undergo primary cesarean delivery. Further adjustment for hospital and physician level cluster correlation resulted in persistently increased risks of primary cesarean delivery in black (54%) and Hispanic patients (12%). CONCLUSION: Hospital site of delivery and individual physician practices do not fully explain racial differences in the risk of primary cesarean delivery.