Gabriel Levin1, Raanan Meyer2, Nizan Mor3, Simcha Yagel4, Mankuta David4, Yoav Yinon2, Amihai Rottenstreich4. 1. Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. Electronic address: Levin.gaby@gmail.com. 2. The Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel. 3. The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. 4. Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Abstract
STUDY OBJECTIVE: Data regarding trial of labor after cesarean delivery (TOLAC) among young women are limited. The aim of this study was to assess the TOLAC success rate and its related factors among adolescents who had never delivered vaginally. DESIGN: A multicenter retrospective cohort study of all adolescent women aged ≤21 years with a history of one previous cesarean delivery, who delivered in two tertiary medical centers during 2007-2019. Women were allocated to two groups: 1) women who underwent TOLAC 2) women who had a repeat cesarean delivery with no trial of labor. Maternal and neonatal outcomes were compared between the two groups. In addition, perinatal outcomes were compared between women with successful and unsuccessful TOLAC. RESULTS: The study cohort included 167 women who had a previous caesarean delivery, 117 underwent TOLAC and 50 underwent a repeat cesarean delivery with no trial of labor. Neonatal birth weight (median 2937 vs. 3170, p=0.03) and gestational age at delivery (median 38 weeks vs. 39, p=0.009) were lower in the repeat cesarean group as compared to those undergoing TOLAC. Overall, 97/117 (83%) had a successful TOLAC. Failed TOLAC was associated low birth weight as compared to successful TOLAC (5 (25%) vs. 7 (7%), OR 4.3 (95% CI 1.2-15.3, p=0.02), and birthweight difference between current and previous deliveries was higher in the failed TOLAC group (median 315 vs. 197 grams, p=0.04). Rates of neonatal Apgar score at 1 minute <7 and of NICU admission were higher in the TOLAC failure group (4 (20%) vs. 5 (5%), OR 4.6 (95% CI 1.1-19.0), p=0.03 and 4 (20%) vs. 4 (4%), OR 5.8 (95% CI 1.3-25.6), p=0.02), respectively). In a multivariable logistic regression analysis, only low birth weight was independently associated with TOLAC failure; aOR 9.9 (95% CI 2.1-45.4, p=0.003). Two cases of uterine rupture occurred in the no trial of labor group, whereas none were encountered in those undergoing TOLAC. CONCLUSIONS: TOLAC in adolescent women who had never delivered vaginally is associated with a relatively high success rate.
STUDY OBJECTIVE: Data regarding trial of labor after cesarean delivery (TOLAC) among young women are limited. The aim of this study was to assess the TOLAC success rate and its related factors among adolescents who had never delivered vaginally. DESIGN: A multicenter retrospective cohort study of all adolescent women aged ≤21 years with a history of one previous cesarean delivery, who delivered in two tertiary medical centers during 2007-2019. Women were allocated to two groups: 1) women who underwent TOLAC 2) women who had a repeat cesarean delivery with no trial of labor. Maternal and neonatal outcomes were compared between the two groups. In addition, perinatal outcomes were compared between women with successful and unsuccessful TOLAC. RESULTS: The study cohort included 167 women who had a previous caesarean delivery, 117 underwent TOLAC and 50 underwent a repeat cesarean delivery with no trial of labor. Neonatal birth weight (median 2937 vs. 3170, p=0.03) and gestational age at delivery (median 38 weeks vs. 39, p=0.009) were lower in the repeat cesarean group as compared to those undergoing TOLAC. Overall, 97/117 (83%) had a successful TOLAC. Failed TOLAC was associated low birth weight as compared to successful TOLAC (5 (25%) vs. 7 (7%), OR 4.3 (95% CI 1.2-15.3, p=0.02), and birthweight difference between current and previous deliveries was higher in the failed TOLAC group (median 315 vs. 197 grams, p=0.04). Rates of neonatal Apgar score at 1 minute <7 and of NICU admission were higher in the TOLAC failure group (4 (20%) vs. 5 (5%), OR 4.6 (95% CI 1.1-19.0), p=0.03 and 4 (20%) vs. 4 (4%), OR 5.8 (95% CI 1.3-25.6), p=0.02), respectively). In a multivariable logistic regression analysis, only low birth weight was independently associated with TOLAC failure; aOR 9.9 (95% CI 2.1-45.4, p=0.003). Two cases of uterine rupture occurred in the no trial of labor group, whereas none were encountered in those undergoing TOLAC. CONCLUSIONS:TOLAC in adolescent women who had never delivered vaginally is associated with a relatively high success rate.