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VBAC Success Overestimated With Induction of Labor
VBAC Success Overestimated With Induction of Labor

Medscape

time12-06-2025

  • Health
  • Medscape

VBAC Success Overestimated With Induction of Labor

MINNEAPOLIS — The vaginal birth after cesarean (VBAC) calculator may overestimate the likely success rate of a VBAC following induction of labor (IOL), according to research presented at American College of Obstetricians and Gynecologists (ACOG) 2025 Annual Meeting. The VBAC calculator does not distinguish between IOL and spontaneous labor, noted Daniel Lorido, MD, MPH, of Montefiore Medical Center in the Bronx, New York, and his colleagues. 'TOLAC [trial of labor after cesarean] patients who are undergoing IOL are significantly less likely to have a successful VBAC as compared to TOLAC patients undergoing spontaneous labor,' Lorido and his colleagues concluded. 'When offering indicated or elective inductions of labor, careful, individualized counseling on the likelihood of VBAC success is essential because a failed trial of labor after cesarean may cause increased perinatal morbidity when compared to successful VBAC or scheduled repeat cesarean delivery.' Noting that TOLAC IOL has higher rates of failure than spontaneous TOLAC, the authors sought to determine the success rate for TOLAC IOL and how it compares to spontaneous IOL and to the VBAC calculator's estimation of success for IOL. The researchers retrospectively analyzed all cases of patients who had a history of one prior cesarean and were undergoing an IOL between January 2020 and December 2023. All 270 patients had full-term, live-born, head-first, singleton births. Just over half the patients (51.1%) had a successful VBAC, but the VBAC calculator had predicted that 63.6% of patients would be successful ( P < .0001). The national rate of successful VBAC is 74.3%, the authors noted, but that includes both IOL and spontaneous labor. Factors associated with a successful VBAC include a history of prior vaginal delivery ( P = .0008), history of a prior VBAC ( P < .0001), and no history of arrest disorder ( P = .0007). Specifically, 72% of patients with a prior vaginal delivery had a successful VBAC after IOL compared to 46% of patients without a previous vaginal delivery. Similarly, 82% of patients with a previous VBAC had a successful VBAC after IOL compared to 43% of patients without a previous VBAC. Among the patients who had a successful VBAC, only 22% had a history of arrest disorder. The researchers did not find any associations between successful VBAC and age, BMI, chronic hypertension, or diabetes — even though age, weight, and treated chronic hypertension are all variables in the VBAC calculator score. Notably, the VBAC calculator was documented as a part of TOLAC counseling in only 11.39% of cases. 'In spite of these findings, we encourage offering TOLAC to all eligible patients while cautioning that accurate success rates be determined and communicated properly,' the authors wrote. 'TOLAC patients should be counseled about lower success rates of VBAC post-IOL to assist in their decision-making process.' It's important to keep in mind when considering these findings that they are all from a single center, Audrey Merriam, MD, MS, an associate professor of obstetrics, gynecology, and reproductive science at Yale School of Medicine, New Haven, Connecticut, told Medscape Medical News . 'There may be practice patterns or preferences at this one center that could impact these results,' Merriam said. She also noted that the study was moderately sized, which also adds caution to interpretation of the findings. That said, the study's key takeaway is that 'the VBAC calculator may not be as accurate when predicting TOLAC success for women who have had any prior cesarean delivery, not just a cesarean delivery for an arrest disorder,' Merriam said. 'The calculator is still just an estimate, so the decision to attempt a VBAC is still between the pregnant person and their physician/provider.' While the calculator provides one piece of information for patients and providers to consider when deciding whether to attempt a TOLAC, 'ultimately, the decision is a shared decision involving risks and benefits between the patient and provider,' Merriam said. The authors did not report receiving any external funding or having any disclosures. Merriam reported having consulted for Lily Link.

Erin Phillips and Daisy Pearce become first AFLW players inducted to hall of fame
Erin Phillips and Daisy Pearce become first AFLW players inducted to hall of fame

The Guardian

time10-06-2025

  • Sport
  • The Guardian

Erin Phillips and Daisy Pearce become first AFLW players inducted to hall of fame

Erin Phillips paid an emotional tribute to her father Greg as she joined him in the Australian Football Hall Of Fame. Phillips and Daisy Pearce are the first AFLW players to be inducted, joining trailblazer Debbie Lee as female inductees. South Australian goalkicking machine Ken Farmer was elevated to legend status at Tuesday night's annual dinner in Melbourne. St Kilda great Nick Riewoldt, whose induction was delayed because of his family move to the United States, joined the Hall of Fame, along with four-time Hawthorn premiership hard nut Luke Hodge and former Melbourne captain Garry Lyon. South Adelaide ruckman Peter Darley, a key member of the club's most recent SANFL premiership in 1964, Tasmanian team of the century vice-captain John Leedham and seven-time East Perth premiership player George Owens are this year's historical inductees. Darley's larrikin speech was one of the highlights of the evening, but Phillips' words to her father were particularly special. 'To Dad, I can't imagine how hard it would have been to tell your 13-year-old daughter that she couldn't play the game she loves any more,' she said. 'And 27 years later, she's standing next to you in the Hall of Fame.' Greg Phillips, a Port Adelaide great, was inducted in 2020, and he and Erin are the first father-daughter selections. Fos and Mark Williams, Hayden Bunton Sr and Jr and umpires Jack McMurray Sr and Jr are the father-son inductees. Pearce and Phillips ended their stellar playing careers at the end of 2022. The five-year player eligibility rule for the hall of fame was changed for women last year. AFLW players can now be inducted within a year of retirement. They were the two obvious players who would benefit first from the rule change. In her speech, Phillips also thanked the 'incredible women' who made the AFLW possible and singled out Lee. 'You kicked down this door so others could walk through,' she said. 'I'm so proud to be by your side and I can't wait to kick down more doors with you Deb.' Pearce's last AFLW game was the Melbourne 2022 grand final victory and she called it the best day of her life, even though her twin children Sylvie and Roy were in the room, hamming it up for the TV cameras. Sign up to From the Pocket: AFL Weekly Jonathan Horn brings expert analysis on the week's biggest AFL stories after newsletter promotion 'It's controversial to say this, as a mother ... don't get me wrong, they're the best thing that's ever happened to me, but on a technicality, the day itself is not that good,' she said. 'Give me grand final day every day of the week.' Phillips was Adelaide's inaugural captain and the first women's best and fairest winner, playing in three Crows flags despite needing a knee reconstruction. She then switched to Port Adelaide when they joined the league in 2022. When the women's league started in 2017, marquee players such as Pearce and Phillips were crucial for its profile and credibility. Pearce returned from having the twins in 2019 to captain Melbourne to the flag. Farmer, who died in 1982, is the SANFL's most prolific goalkicker, with 1417 for North Adelaide from 1929-41 in 224 games at an extraordinary average of 6.33 per game. He was never goalless in a game and coached the Roosters to two premierships. Riewolt went agonisingly close to a premiership, playing in St Kilda's draw and two losses across 2009-10. He said he had made his peace with not being able to help the Saints win their elusive second flag 'Rather than feeling like I walked away with the game still owing me something, I walk away feeling like the game gave me absolutely everything,' he said.

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