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. 2021 Apr;28(4):1092-1100.
doi: 10.1007/s43032-020-00378-1. Epub 2020 Nov 13.

Maternal and Neonatal Outcomes Following Trial of Labor After Two Previous Cesareans: a Retrospective Cohort Study

Reut Rotem  1 , Ayala Hirsch #  2 , Hen Y Sela  2 , Arnon Samueloff  2 , Sorina Grisaru-Granovsky  2 , Misgav Rottenstreich  2   3
Affiliations

Maternal and Neonatal Outcomes Following Trial of Labor After Two Previous Cesareans: a Retrospective Cohort Study

Reut Rotem et al. Reprod Sci. 2021 Apr.

Abstract

The objective of this study is to evaluate the maternal and neonatal outcomes of parturients attempting trial of labor (TOL) after two previous CD versus those who had an elective third repeat CD. A retrospective computerized database cohort study was conducted at a single tertiary center between 2005 and 2019. Various maternal and neonatal outcomes were compared between parturients attempting TOL after two CD versus parturients opting for elective third repeat CD. TOL after two CD was allowed only for those who met all the criteria of our departments' protocol. Parturients with identified contraindication to vaginal delivery were excluded from the analysis. A univariate analysis was conducted and was followed by a multivariate analysis. A total of 2719 eligible births following two CD were identified, of which 485 (17.8%) had attempted TOL. Successful vaginal delivery rate following two CDs was 86.2%. Uterine rupture rates were higher among those attempting TOL (0.6% vs 0.1% p = 0.04). However, rates of hysterectomy, re-laparotomy, blood product infusion, and intensive care unit admission did not differ significantly between the groups. Neonatal outcomes following elective repeat CD were less favorable (specifically, neonatal intensive care unit admission and composite adverse neonatal outcome). Nonetheless, when controlling for potential confounders, an independent association between composite adverse neonatal outcome and an elective repeat CD was not demonstrated. In a subgroup analysis, diabetes mellitus and hypertensive disorders of pregnancy were found independently associated with failed TOLAC. When following a strict protocol, TOL after two CD is a reasonable alternative and associated with favorable outcomes.

Keywords: Multiple cesarean deliveries; TOLAC; Uterine rupture; VBAC.

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References

    1. Boerma T, Ronsmans C, Melesse DY, Barros AJD, Barros FC, Juan L, et al. Global epidemiology of use of and disparities in caesarean sections. Lancet. 2018;392(10155):1341–8. https://doi.org/10.1016/S0140-6736(18)31928-7 . - DOI - PubMed
    1. Zhang J, Troendle J, Reddy UM, et al. Contemporary cesarean delivery practice in the United States. Am J Obstet Gynecol. 2010;203(4):326.e1–326.e10. https://doi.org/10.1016/j.ajog.2010.06.058 . - DOI
    1. Silver RM, Landon MB, Rouse DJ, et al. Repeat Cesarean Deliveries. 2006;107(6):1226–32.
    1. Sandall J, Tribe RM, Avery L, Mola G, Visser GHA, Homer CSE, et al. Optimising caesarean section use 2 short-term and long-term effects of caesarean section on the health of women and children. Lancet. 2018;392(10155):1349–57. https://doi.org/10.1016/S0140-6736(18)31930-5 . - DOI - PubMed
    1. Trojano G, Damiani GR, Olivieri C, et al. VBAC: antenatal predictors of success. Acta Biomed. 2019;90(3):300–9. https://doi.org/10.23750/abm.v90i3.7623 . - DOI - PubMed - PMC

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