No abstract

Elective repeat cesarean delivery (ERCD) carries an inherent risk for maternal morbidity and economic costs. Therefore, reducing the rising rates of ERCD worldwide is paramount. 1,2 Trial of labor after cesarean (TOLAC) is an alternative to ERCD and represents an effective option to reduce cesarean delivery rates. When successful vaginal birth after cesarean (VBAC) is achieved, it is associated with lower rates of perinatal adverse outcomes. 1,3 As failure of TOLAC is associated with adverse neonatal and maternal outcomes, including postpartum hemorrhage, uterine rupture, perinatal mortality, and hypoxic-ischemic encephalopathy, 4,5 efforts

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.

No abstract

Objective To characterize the length of the second stage of labor among women completing a first vaginal birth after a cesarean (VBAC), according to the stage of labor during primary cesarean delivery (CD). Methods A retrospective cohort study of VBACs between 2011 and 2020. Study groups were divided as follows: CD not in labor, CD in the first stage of labor, and CD in the second stage of labor. The primary outcome was the length of the second stage. Results A total of 1310 VBACs were included. The timing of the primary CD was not associated with the duration of the second stage. The median second stage of duration of VBACs with previous first stage CD versus previous CD not in labor was 81 versus 106 min, respectively (P = 0.050). In multivariable linear regression, maternal age, birth weight, and epidural were independently associated with second‐stage length. Maternal and neonatal outcomes did not differ between study groups and were not affected by the second‐stage length. Conclusion When stratified according to the labor stage of the primary CD, second‐stage duration among women completing VBACs was not associated with labor stage at the primary CD. Extremes of the second‐stage duration were not associated with increased morbidity.