OBJECTIVE: Our aim was to compare good candidates for trial of labor after cesarean (TOLAC) who underwent repeat cesarean to those who chose TOLAC. STUDY DESIGN: Data for all deliveries at 14 regional hospitals over an 8-year period were reviewed. Women with a primary cesarean and 1 subsequent delivery in the dataset were included. The choice of elective repeat cesarean vs TOLAC was assessed in the first delivery following the primary cesarean. Women with ≥70% chance of successful vaginal birth after cesarean as calculated by a published nomogram were considered good candidates for TOLAC. Good candidates who chose an elective repeat cesarean were compared to those who chose TOLAC. Women who were delivered at 2 preselected tertiary centers by a general obstetrician-gynecologist practice were subanalyzed to determine whether there was an effect of physician group. RESULTS: In all, 5445 women had a primary cesarean and a subsequent delivery. A total of 3120 women were calculated to be good TOLAC candidates. Of this group, 925 (29.7%) chose TOLAC. Women managed by a family practitioner or who were obese were less likely to choose TOLAC while women who were managed by a midwife or had a prior vaginal delivery were more likely to choose TOLAC. At the 2 tertiary centers, 1 general obstetrician-gynecologist group had significantly more patients who chose TOLAC compared to the other obstetrician-gynecologist physician groups (P < .001), with 63% of their patients choosing TOLAC. CONCLUSION: Less than one-third of the good candidates for TOLAC chose TOLAC. Managing provider influences this decision.
OBJECTIVE: Our aim was to compare good candidates for trial of labor after cesarean (TOLAC) who underwent repeat cesarean to those who chose TOLAC. STUDY DESIGN: Data for all deliveries at 14 regional hospitals over an 8-year period were reviewed. Women with a primary cesarean and 1 subsequent delivery in the dataset were included. The choice of elective repeat cesarean vs TOLAC was assessed in the first delivery following the primary cesarean. Women with ≥70% chance of successful vaginal birth after cesarean as calculated by a published nomogram were considered good candidates for TOLAC. Good candidates who chose an elective repeat cesarean were compared to those who chose TOLAC. Women who were delivered at 2 preselected tertiary centers by a general obstetrician-gynecologist practice were subanalyzed to determine whether there was an effect of physician group. RESULTS: In all, 5445 women had a primary cesarean and a subsequent delivery. A total of 3120 women were calculated to be good TOLAC candidates. Of this group, 925 (29.7%) chose TOLAC. Women managed by a family practitioner or who were obese were less likely to choose TOLAC while women who were managed by a midwife or had a prior vaginal delivery were more likely to choose TOLAC. At the 2 tertiary centers, 1 general obstetrician-gynecologist group had significantly more patients who chose TOLAC compared to the other obstetrician-gynecologist physician groups (P < .001), with 63% of their patients choosing TOLAC. CONCLUSION: Less than one-third of the good candidates for TOLAC chose TOLAC. Managing provider influences this decision.
Authors: Sindhu K Srinivas; David M Stamilio; Erika J Stevens; Anthony O Odibo; Jeffrey F Peipert; George A Macones Journal: Obstet Gynecol Date: 2007-04 Impact factor: 7.661
Authors: William A Grobman; Yinglei Lai; Mark B Landon; Catherine Y Spong; Kenneth J Leveno; Dwight J Rouse; Michael W Varner; Atef H Moawad; Steve N Caritis; Margaret Harper; Ronald J Wapner; Yoram Sorokin; Menachem Miodovnik; Marshall Carpenter; Mary J O'Sullivan; Baha M Sibai; Oded Langer; John M Thorp; Susan M Ramin; Brian M Mercer Journal: Obstet Gynecol Date: 2007-04 Impact factor: 7.661
Authors: M G Pickhardt; J N Martin; E F Meydrech; P G Blake; R W Martin; K G Perry; J C Morrison Journal: Am J Obstet Gynecol Date: 1992-06 Impact factor: 8.661
Authors: Miriam Kuppermann; Anjali J Kaimal; Cinthia Blat; Juan Gonzalez; Mari-Paule Thiet; Yamilee Bermingham; Anna L Altshuler; Allison S Bryant; Peter Bacchetti; William A Grobman Journal: JAMA Date: 2020-06-02 Impact factor: 56.272
Authors: Patrick D Thornton; Kylea Liese; Kirby Adlam; Katherine Erbe; Barbara L McFarlin Journal: J Midwifery Womens Health Date: 2020-08-04 Impact factor: 2.388