Outcomes associated with trial of labor after cesarean in women with one versus two prior cesarean deliveries after a change in clinical practice guidelines in an academic hospital*

Davidson, Christina; Bellows, Patricia H.; Shah, Utsavi; Hawley, Lauren; Drexler, Kathleen; Gandhi, Manisha; Eppes, Catherine; Sangi‐Haghpeykar, Haleh

doi:10.1080/14767058.2018.1520831

Cited by 9 publications

(12 citation statements)

References 12 publications

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“…Results from studies that have been conducted regarding the safety and feasibility of TOLAC in women with two previous cesarean deliveries are presented in ►Table 6 and include the results of this investigation. 6,[8][9][10][11][12][13][14] Studies have compared the outcomes of TOLAC2 to those of TOLAC1, which is more commonly practiced and often encouraged. Other studies have compared outcomes of TOLAC2 to the clinical alternative of a third elective repeat cesarean delivery 6,11,13,14 and have demonstrated that a third cesarean delivery carries its own immediate maternal and neonatal risks, including uterine rupture, hysterectomy, need for blood product transfusion or relaparotomy, as well as adverse neonatal outcomes including neonatal intensive care unit admission and respiratory morbiditiy.…”

Section: Discussionmentioning

confidence: 99%

The Feasibility of a Trial of Labor after Two Cesarean Deliveries: Outcomes and Prognostic Factors for Success

et al. 2023

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To determine whether a trial of labor after two cesarean deliveries increases the risk of adverse maternal and neonatal outcomes and identify prognostic factors for TOLAC2 success.A retrospective cohort study was conducted The study group was comprised of women with two caesarean deliveries who attempted TOLAC (TOLAC2). Outcomes were compared to women undergoing TOLAC after one previous cesarean delivery (TOLAC1). The primary outcome was TOLAC success. Secondary outcomes included mode of delivery, uterine rupture, and combined adverse outcome(CAO) (uterine rupture, PPH, 5 minute Apgar < 7, pH < 7.1). Logistic regression was used for the multivariate analysis to identify prognostic factors for TOLAC2 success. 381 women who underwent TOLAC2 were compared to 3635 women who underwent TOLAC1. Women attempting TOLAC2 were less likely to achieve VBAC (80.8% and 92.5% OR 0.35 95% CI 0.26-0.47 p<0.001) and more likely to experience uterine rupture (0.8%Vs0.2% OR 4.1 95% CI 1.1-15.9 p=0.02) but not CAO (4.2% Vs 4.8% OR 0.88 95% CI 0.5-1.5 p=0.3). TOLAC2 women with no previous vaginal deliveries had a lower chance of VBAC and a higher risk of uterine rupture compared to TOLAC1 patientswomen without a prior vaginal delivery (45.2% vs 86.3% OR 0.13 95% CI 0.07-0.25 p<0.001) (2.3% Vs 0%) and TOLAC2 women with a prior vaginal delivery(45.2% Vs 85.3% OR 0.14 95% CI 0.1-0.3 p<0.0001) (2.4% Vs 0.6% OR 4.1 95% CI 0.4-46.3 p=0.3). Multivariate analysis revealed that a history of vaginal delivery is an independent predictor of TOLAC 2 success. Women attempting TOLAC2 are less likely to achieve VBAC and are at greater risk of uterine rupture compared to those attempting TOLAC1. Prior vaginal delivery seems to have a protective effect on TOLAC outcomes. This data should be used to counsel patientswomen and assist in decision-making when considering the mode of delivery in patientsw

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Section: Discussionmentioning

confidence: 99%

The Feasibility of a Trial of Labor after Two Cesarean Deliveries: Outcomes and Prognostic Factors for Success

et al. 2023

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“…Our success rate for vaginal delivery of 67.3% is in line with the literature which found success rates between 62.8% and 74.6%. [8,[18][19][20][21]. The success of the trial of labor is an important point because cesarean sections during labor might be more morbid than elective cesarean sections [22].…”

Section: Predictive Factors For Successful Vaginal Deliverymentioning

confidence: 99%

“…The main strength of our study is that it included only patients with two previous cesarean and compared the two strategies in an intention to treat strategy. Most of the available studies for the management of patients with two previous cesarean sections compare the outcomes of women with one versus two previous cesarean sections deliveries [16,17,19,20,[24][25][26]. Few studies, even national ones, address this issue, as the strategy of allowing vaginal delivery after two cesarean sections is in the minority.…”

Section: Strengths and Weaknessesmentioning

confidence: 99%

Trial of labor versus elective cesarean delivery for patients with two prior cesarean-sections: A retrospective propensity score analysis

Roux,

Chiemlewski,

Lassel

et al. 2023

European Journal of Obstetrics & Gynecology and Reproductiv

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“…Мировое сообщество единодушно признало попытку вагинальных родов после КС (англ. trial of labor after cesarean, TOLAC) [10][11][12][13], не исключая ее после двух и более КС [14], допуская преиндукцию/индукцию родов [15,16]. Пересмотренные отечественные клинические рекомендации расширили перспективы для родоразрешения через естественные родовые пути после КС [3,17].…”

Section: Introductionunclassified

“…Пересмотренные отечественные клинические рекомендации расширили перспективы для родоразрешения через естественные родовые пути после КС [3,17]. Чрезмерные, не всегда оправданные ограничения для консервативных родов после КС представляют не менее серьезные риски, сопряженные с третьим и более абдоминальным родоразрешением [14].…”

Section: Introductionunclassified

An Alternative to Repeat Cesarean Section

Vuchenovich¹,

Новикова²,

Radzinsky³

2020

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Цель исследования: повысить эффективность консервативного родоразрешения женщин с кесаревым сечением (КС) в анамнезе. Дизайн: проспективное многоцентровое когортное исследование. Материалы и методы. Исследование проводилось в 2013-2019 гг. на базе родильных домов № 68 и № 29 г. Москвы с участием 372 беременных женщин с КС в анамнезе, настаивавших на вагинальных родах. Выбор метода родоразрешения опирался на клинические протоколы. Бинарный исход на основании независимого предиктора прогнозировали при помощи бинарной логистической регрессии, числовую или категориальную переменную на основании одного или нескольких числовых или категориальных предикторов-при помощи регрессии автоматизированных нейронных сетей. Результаты. У 43,55% женщин вагинальные роды исключены по акушерским/неакушерским показаниям, 56,45% (в том числе при двух КС) имели шанс на родоразрешение через естественные родовые пути. Спонтанная/индуцированная родовая деятельность развилась у 51,08% пациенток исследуемой когорты, из них завершилась вагинальными родами у 52,63%. Интранатальными препятствиями для реализации попытки вагинальных родов были неэффективность лечения слабости родовой деятельности, невозможность исключить начавшийся разрыв матки. Заключение. Женщина вправе претендовать на вагинальные роды после КС, но подход к выбору метода родоразрешения должен быть обоснованным. Возможности мегаполиса позволяют предпринять попытку вагинальных родов у 56,45% женщин с КС (одним или двумя). Ключевые слова: попытка вагинальных родов, повторное кесарево сечение, начавшийся разрыв матки, индукция родов.

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Outcomes associated with trial of labor after cesarean in women with one versus two prior cesarean deliveries after a change in clinical practice guidelines in an academic hospital*

Cited by 9 publications

References 12 publications

The Feasibility of a Trial of Labor after Two Cesarean Deliveries: Outcomes and Prognostic Factors for Success

The Feasibility of a Trial of Labor after Two Cesarean Deliveries: Outcomes and Prognostic Factors for Success

Trial of labor versus elective cesarean delivery for patients with two prior cesarean-sections: A retrospective propensity score analysis

An Alternative to Repeat Cesarean Section

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