Gabriel Levin1,2, Abraham Tsur3,4, Lee Tenenbaum4, Nizan Mor4, Michal Zamir4, Raanan Meyer3,4. 1. Department of Gynecologic Oncology, Hadassah-Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel. 2. Faculty of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. 3. Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel. 4. Faculty of Medicine, Tel-Aviv-Hebrew University, Tel-Aviv, Israel.
Abstract
OBJECTIVE: To study the factors associated with successful trial of labor after cesarean (TOLAC) among women with diabetes and no prior vaginal delivery and compare with TOLAC in nondiabetic women. METHODS: A retrospective study including all women undergoing TOLAC who had no prior vaginal delivery between March 2011 and June 2020 at Sheba Medical Center. Women with diabetic disorders were compared with those without. Multivariate regression analysis was performed to identify factors independently associated with TOLAC success. RESULTS: Of 2144 deliveries with TOLAC, 163 (7.6%) were to women with a diabetic disorder. TOLAC success rate was comparable between diabetic and nondiabetic women (124 [76.1%] vs 1513 [76.4%], respectively; P = 0.931). Uterine rupture rate was 1.1% (23 out of 2144). Among women with diabetes the uterine rupture rate was 0.6% (1 out of 163) and did not differ between the success or fail TOLAC groups. Multivariate logistic regression showed that epidural anesthesia and cervical effacement were the only independent factors associated with TOLAC success in women with diabetes (adjusted OR 3.32; 95% CI, 1.31-8.69, P = 0.011 and aOR 1.04; 95% CI, 1.01-1.07, P = 0.007, respectively). CONCLUSION: TOLAC in women with diabetes with no prior vaginal delivery has a high success rate. Epidural analgesia is the only modifiable independent predictor of TOLAC success.
OBJECTIVE: To study the factors associated with successful trial of labor after cesarean (TOLAC) among women with diabetes and no prior vaginal delivery and compare with TOLAC in nondiabetic women. METHODS: A retrospective study including all women undergoing TOLAC who had no prior vaginal delivery between March 2011 and June 2020 at Sheba Medical Center. Women with diabetic disorders were compared with those without. Multivariate regression analysis was performed to identify factors independently associated with TOLAC success. RESULTS: Of 2144 deliveries with TOLAC, 163 (7.6%) were to women with a diabetic disorder. TOLAC success rate was comparable between diabetic and nondiabetic women (124 [76.1%] vs 1513 [76.4%], respectively; P = 0.931). Uterine rupture rate was 1.1% (23 out of 2144). Among women with diabetes the uterine rupture rate was 0.6% (1 out of 163) and did not differ between the success or fail TOLAC groups. Multivariate logistic regression showed that epidural anesthesia and cervical effacement were the only independent factors associated with TOLAC success in women with diabetes (adjusted OR 3.32; 95% CI, 1.31-8.69, P = 0.011 and aOR 1.04; 95% CI, 1.01-1.07, P = 0.007, respectively). CONCLUSION: TOLAC in women with diabetes with no prior vaginal delivery has a high success rate. Epidural analgesia is the only modifiable independent predictor of TOLAC success.