Vaginal deliveries after cesarean section: Heterogeneity of outcome according to the hospital policies in Italy

Objective: assessing the characteristics of some Italian women with previous Cesarean section and to establish predictors for failure of trial of labour after Cesarean. It was hypothesized that local policies of facilities could affect the success of trial of labour after Cesarean. Methods: retrospective study included 328 pregnant women at term, with one previous Cesarean section and a cephalic singleton pregnancy, enrolled in four hospitals of the Emilia Romagna, Italy. Multivariate logistic regression models was built and assessment of heterogeneity of data (Q-statistic) was also performed. Results: the factors involved in the failure of vaginal birth after Cesarean seems to be the ones already reported in literature. However, even the hospital where patients delivered matters on the vaginal birth after Cesarean. Very high heterogeneity among hospitals was found. Conclusions: local policies about the management of women with previous Cesarean section affect the proportion of vaginal birth after Cesarean. This finding is a concern if rates of vaginal births after Cesarean are compared among Italian hospitals and worldwide.