rates of fetal macrosomia or maternal obesity. Women undergoing TOLAC without a prior vaginal delivery compared to women undergoing TOLAC with a prior vaginal delivery were older (median age, 24 vs. 19 y, P < 0.001), were of higher gravidity (2 vs. 1, P < 0.001), and more likely had body mass index of >30 kg/m 2 (relative risk, 1.39; 95 confidence interval, 1.03-1.89). These 2 groups did not differ significantly in rates of cervical dilation; median times for dilation from 4 to 10 cm were 3.0 hours for TOLAC and 2.8 hours for non-TOLAC patients. In women without a previous vaginal delivery, the median time of the active phase of labor did not differ based on the presence of a uterine scar and was 3.7 hours in both groups. Labor curves, when stratified by TOLAC status, overlapped and revealed a gradual transition from the latent to active phase. No deceleration phase was noted.On the basis of these results, women undergoing TOLAC should be managed by the same standards as women without a uterine scar, which does not seem to affect the pattern of the first stage of spontaneous labor.
Topics: Obstetric ComplicationsI nduction of labor is frequently used for postdate pregnancies (>41 wk gestation) to decrease perinatal mortality. However, no trial or meta-analysis with sufficient sample size has yet examined the effects of labor induction on perinatal mortality between 37 and 41 weeks' gestation. This retrospective cohort study was undertaken to determine neonatal and maternal outcomes after elective induction of labor compared with expectant management.Data were obtained from several Scottish databases, including the General Register Office for Scotland database, which links maternity, neonatal, and stillbirth/infant death records. Deliveries between January 1981 and December 2007 were examined. Women were considered as having elective inductions if they had no medical indications for induction of labor. These women, induced at 37, 38, 39, 40, and 41 weeks' gestation, were compared with women who had expectant management with continuation of pregnancy to either spontaneous labor, induction of labor, or cesarean section at a later gestation. Outcomes examined included extended perinatal mortality, admission of neonate to the neonatal intensive care unit, mode of delivery, postpartum hemorrhage, obstetric anal sphincter injury, shoulder dystocia, and uterine rupture. Extended perinatal mortality was defined as stillbirth and death in the first month of life, excluding deaths related to congenital anomalies. These outcomes were adjusted for age at delivery, parity, year of birth, birth weight, deprivation category (defined by post code), and mode of delivery.From 1,605,601 deliveries during the study period, 176,136 women had elective induction of labor and 938,364 did not have induction. Women undergoing induction of labor were older, more likely to be primiparous, and less likely to be in the 2 highest level categories of deprivation. Labor inductions decreased from 1981 to 1990 but then began rising and peaked in 20...
