Maya Ram1, Liran Hiersch2, Eran Ashwal2, Daniel Nassie3, Anat Lavie2, Yariv Yogev2, Amir Aviram2. 1. Departments of Obstetrics and Gynecology, Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center (affiliated with the Sackler Faculty of Medicine, Tel Aviv University), Tel Aviv, Israel. maya3000@gmail.com. 2. Departments of Obstetrics and Gynecology, Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center (affiliated with the Sackler Faculty of Medicine, Tel Aviv University), Tel Aviv, Israel. 3. The Helen Schneider Hospital for Women, Rabin Medical Center (affiliated with the Sackler Faculty of Medicine, Tel Aviv University), Petah Tikva, Israel.
Abstract
PURPOSE: To stratify maternal and neonatal outcomes of trials of labor after previous cesarean delivery (TOLAC) by gestational age. METHODS: Retrospective cohort study of all singleton pregnancies with one previous cesarean delivery in TOLAC at term between 2007 and 2014. We compared outcomes of delivery at an index gestational week, with outcomes of women who remained undelivered at this index gestational week (ongoing pregnancy). Odds ratios and 95% confidence intervals were adjusted for maternal age, previous vaginal delivery, induction of labor, epidural use, presence of meconium, and birth weight > 4000 g. RESULTS: Overall, 2849 women were eligible for analysis. Of those, 2584 (90.7%) had a successful TOLAC and 16 women (0.56%) had uterine rupture. Those rates did not differ significantly for any gestational age (GA) group. Following adjustment for possible confounders, GA was not found to be independently associated with adverse maternal or neonatal outcomes. CONCLUSION: Among women at term with a single previous cesarean delivery, GA at delivery was not found to be an independent risk factor for TOLAC success or uterine rupture. We suggest that GA by itself will not serve as an argument for or against TOLAC.
PURPOSE: To stratify maternal and neonatal outcomes of trials of labor after previous cesarean delivery (TOLAC) by gestational age. METHODS: Retrospective cohort study of all singleton pregnancies with one previous cesarean delivery in TOLAC at term between 2007 and 2014. We compared outcomes of delivery at an index gestational week, with outcomes of women who remained undelivered at this index gestational week (ongoing pregnancy). Odds ratios and 95% confidence intervals were adjusted for maternal age, previous vaginal delivery, induction of labor, epidural use, presence of meconium, and birth weight > 4000 g. RESULTS: Overall, 2849 women were eligible for analysis. Of those, 2584 (90.7%) had a successful TOLAC and 16 women (0.56%) had uterine rupture. Those rates did not differ significantly for any gestational age (GA) group. Following adjustment for possible confounders, GA was not found to be independently associated with adverse maternal or neonatal outcomes. CONCLUSION: Among women at term with a single previous cesarean delivery, GA at delivery was not found to be an independent risk factor for TOLAC success or uterine rupture. We suggest that GA by itself will not serve as an argument for or against TOLAC.
Entities:
Keywords:
Maternal outcome; Neonatal outcome; Trial of labor after cesarean delivery; Uterine rupture; Vaginal birth after cesarean delivery
Authors: P Hidalgo-Lopezosa; A M Cubero-Luna; J Huertas-Marín; M Hidalgo-Maestre; A J De la Torre-González; M A Rodríguez-Borrego; P J López-Soto Journal: Women Birth Date: 2021-12-24 Impact factor: 3.172
Authors: George Gitas; Ibrahim Alkatout; Kubilay A Ertan; Achim Rody; Louisa Proppe; Mustafa Kocaer; Antonio Simone Laganà; Leila Allahqoli; Themistoklis Mikos; Soteris Sommer; Sascha Baum Journal: J Turk Ger Gynecol Assoc Date: 2022-07-05