Gabriel Levin1,2,3, Abraham Tsur4,5, Lee Tenenbaum5, Nizan Mor5, Michal Zamir5, Raanan Meyer4,5. 1. The Department of Gynecologic Oncology, Hadassah Medical Center, Jerusalem, Israel. levin.gaby@gmail.com. 2. Faculty of Medicine, Hebrew University, Jerusalem, Israel. levin.gaby@gmail.com. 3. Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Hadassah-Hebrew University Medical Center, POB 12000, 91120, Ramat-GanJerusalem, Israel. levin.gaby@gmail.com. 4. Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Hadassah-Hebrew University Medical Center, POB 12000, 91120, Ramat-GanJerusalem, Israel. 5. Faculty of Medicine, Tel-Aviv-Hebrew University, Tel-Aviv, Israel.
Abstract
KEY MESSAGE: Trial of labor among women who never delivered vaginally with hypertensive disorder is associated with nearly half the success rate of the general population. PURPOSE: To study the trial of labor after cesarean (TOLAC) among women with hypertensive disorders and no prior vaginal delivery. METHODS: A retrospective cohort study was conducted including women with no prior vaginal delivery undergoing TOLAC during 2010-2020. Women with hypertensive disorder were compared to those without. RESULTS: A total of 54/2,144 (2.5%) TOLACs had a hypertensive disorder: 32 (59%) had gestational hypertension, 16 (30%) had chronic hypertension and 6 (11%) had preeclampsia. Women with hypertensive disorders had higher BMI and higher proportion of diabetic disorders. TOLAC success rate was lower among hypertensive mothers: 32 (59%) vs. 1,605 (76.8%), p=0.003 odds ratio (OR), 95% confidence interval (CI) 0.44 (0.25-0.76). The rate of uterine rupture was 23/2,144 (1.1%). In a multivariable logistic regression analysis, hypertensive disorder was independently negatively associated with TOLAC success, adjusted OR (95% CI) 0.47 (0.26-0.85). Other factors negatively independently associated with TOLAC failure were maternal age, predelivery body mass index, dystocia at primary CD, gestational age at TOLAC, induction of labor and birth weight. Epidural was independently positively associated with TOLAC success, adjusted OR (95% CI) 1.54 (1.18-1.99). CONCLUSION: TOLAC in hypertensive women with no prior vaginal delivery is safe. Success rate is impaired in comparison to non-hypertensive women.
KEY MESSAGE: Trial of labor among women who never delivered vaginally with hypertensive disorder is associated with nearly half the success rate of the general population. PURPOSE: To study the trial of labor after cesarean (TOLAC) among women with hypertensive disorders and no prior vaginal delivery. METHODS: A retrospective cohort study was conducted including women with no prior vaginal delivery undergoing TOLAC during 2010-2020. Women with hypertensive disorder were compared to those without. RESULTS: A total of 54/2,144 (2.5%) TOLACs had a hypertensive disorder: 32 (59%) had gestational hypertension, 16 (30%) had chronic hypertension and 6 (11%) had preeclampsia. Women with hypertensive disorders had higher BMI and higher proportion of diabetic disorders. TOLAC success rate was lower among hypertensive mothers: 32 (59%) vs. 1,605 (76.8%), p=0.003 odds ratio (OR), 95% confidence interval (CI) 0.44 (0.25-0.76). The rate of uterine rupture was 23/2,144 (1.1%). In a multivariable logistic regression analysis, hypertensive disorder was independently negatively associated with TOLAC success, adjusted OR (95% CI) 0.47 (0.26-0.85). Other factors negatively independently associated with TOLAC failure were maternal age, predelivery body mass index, dystocia at primary CD, gestational age at TOLAC, induction of labor and birth weight. Epidural was independently positively associated with TOLAC success, adjusted OR (95% CI) 1.54 (1.18-1.99). CONCLUSION: TOLAC in hypertensive women with no prior vaginal delivery is safe. Success rate is impaired in comparison to non-hypertensive women.
Authors: P Reif; C Brezinka; T Fischer; P Husslein; U Lang; A Ramoni; H Zeisler; P Klaritsch Journal: Geburtshilfe Frauenheilkd Date: 2016-12 Impact factor: 2.915
Authors: Christine L Roberts; Jane B Ford; Charles S Algert; Sussie Antonsen; James Chalmers; Sven Cnattingius; Manjusha Gokhale; Milton Kotelchuck; Kari K Melve; Amanda Langridge; Carole Morris; Jonathan M Morris; Natasha Nassar; Jane E Norman; John Norrie; Henrik Toft Sørensen; Robin Walker; Christopher J Weir Journal: BMJ Open Date: 2011-05-24 Impact factor: 2.692