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Multicenter Study
. 2024 Oct;31(10):3183-3190.
doi: 10.1007/s43032-024-01645-1. Epub 2024 Jul 11.

Maternal Morbidity following Trial of Labor after Cesarean in Women Experiencing Antepartum Fetal Death

Ela Kadish #  1 , Tzuria Peled #  1 , Hen Y Sela  1 , Ari Weiss  1 , Shaked Shmaya  2 , Sorina Grisaru-Granovsky  1 , Misgav Rottenstreich  3   4   5
Affiliations
Multicenter Study

Maternal Morbidity following Trial of Labor after Cesarean in Women Experiencing Antepartum Fetal Death

Ela Kadish et al. Reprod Sci. 2024 Oct.

Abstract

This study aims to investigate whether trial of labor after cesarean delivery (TOLAC) in women with antepartum fetal death, is associated with an elevated risk of maternal morbidity. A retrospective multicenter. TOLAC of singleton pregnancies following a single low-segment incision were included. Maternal adverse outcomes were compared between women with antepartum fetal death and women with a viable fetus. Controls were matched with cases in a 1:4 ratio based on their previous vaginal births and induction of labor rates. Univariate analysis was followed by multiple logistic regression modeling. During the study period, 181 women experienced antepartum fetal death and were matched with 724 women with viable fetuses. Univariate analysis revealed that women with antepartum fetal death had significantly lower rates of TOLAC failure (4.4% vs. 25.1%, p < 0.01), but similar rates of composite adverse maternal outcomes (6.1% vs. 8.0%, p = 0.38) and uterine rupture (0.6% vs. 0.3%, p = 0.56). Multivariable analyses controlling for confounders showed that an antepartum fetal death vs. live birth isn't associated with the composite adverse maternal outcomes (aOR 0.96, 95% CI 0.21-4.44, p = 0.95). TOLAC in women with antepartum fetal death is not associated with an increased risk of adverse maternal outcomes while showing high rates of successful vaginal birth after cesarean (VBAC).

Keywords: Cesarean delivery; Fetal death; Fetal demise; Stillbirth; Trial of labor; Uterine rupture.

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Conflict of interest statement

The authors report no conflict of interest.

The authors declare that they have nothing to disclose and that they have no financial or non-financial conflict of interest.

Figures

Fig. 1
Fig. 1
Study Population Schematic Flowchart
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