Emergent cesarean delivery in patients undergoing a trial of labor with a transverse lower-segment scar

Objective This study was aimed to evaluate success rates of (1) external cephalic version (ECV) among women with one prior cesarean delivery (CD) and (2) maternal and neonatal outcomes after ECV among women with prior CD. Study Design Two linked studies using U.S. Natality Database were performed. First we performed a retrospective cohort comparing ECV success rates of women with prior CD and women without prior CD. Then we compared the outcomes of TOLACs (trial of labor after cesarean delivery) that occurred after ECV with those that occurred without ECV. Multivariable logistic regression analysis was used to estimate adverse outcomes. Results A total of 715 women had ECV after 36 weeks with prior CD and 9,976 had ECV without prior scar. ECV success rate with scar was 80.6% and without scar was 86.4% (p < 0.001). Seven hundred and sixteen women underwent TOLAC after ECV attempt and 234,617 underwent TOLAC without a preceding attempt. Women with preceding version had increased risks of maternal transfusion (1 vs. 0.4%, adjusted OR [odds ratio]: 2.48 [95% CI (confidence interval): 1.17–5.23]), unplanned hysterectomy (0.4 vs. 0.06%, adjusted OR: 6.90 [95% CI: 2.19–21.78]), and low 5-minute Apgar's score (2.5 vs. 1.5%, adjusted OR: 1.76 [95% CI: 1.10–2.82]). Conclusion Women with prior CD may have a decrease in the rate of successful ECV. While the absolute risks are low, ECV appears to increase risks of adverse maternal and neonatal outcomes among women undergoing a trial of labor.

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Predictors of success of trial of labor after cesarean section: A nested case–control study at public hospitals in Eastern Ethiopia

Women s Health ◽

10.1177/17455065211061960 ◽

2021 ◽

Vol 17 ◽

pp. 174550652110619

Author(s):

Maleda Tefera ◽

Nega Assefa ◽

Kedir Teji Roba ◽

Letta Gedefa

Keyword(s):

Cesarean Section ◽

Cesarean Delivery ◽

Vaginal Birth ◽

Public Hospitals ◽

Vaginal Birth After Cesarean ◽

Eastern Ethiopia ◽

Trial Of Labor ◽

History Of ◽

Nested Case Control

Background: One of the primary reasons for an increase in cesarean sections is obstetricians’ uncertainty about labor trial safety following a previous cesarean section. The success rate of vaginal birth after cesarean section with a single cesarean scar is greater than 50%. However, to the best of our knowledge, there is a scarcity of information on the determinants of vaginal birth after cesarean delivery in the study area. As a result, the purpose of this study was to identify predictors of successful vaginal birth after cesarean delivery in public hospitals in Eastern Ethiopia. Methods: A nested case–control study design was used within a prospective follow-up study conducted from June to October 2020. A total of 220 women who tried vaginal birth after cesarean delivery was included, 110 cases and 110 controls. Cases were women with one previous cesarean section scar and successfully proceed with vaginal delivery. The controls were those with an earlier cesarean section scar and delivered by emergency cesarean section after trial of labor. A pre-tested structured questionnaire was used to gather the information. Multiple logistic regression is used to identify the determinants for the success of vaginal birth after cesarean section; odds ratio with its 95% CI are used to report the findings. Results: We found that living in rural areas (AOR = 2.28; 95% CI (1.85, 12.41)), having a current antenatal care follow-up (AOR = 3.20; 95% CI (1.15, 8.87)) and partograph monitoring of labor (AOR = 4.26; 95% CI (1.90, 9.57)) had a positive association with successful vaginal birth after cesarean section. In contrast, the presence of meconium-stained amniotic liquor (AOR = 0.10; 95% CI (0.01, 0.75)) and history of stillbirth (AOR = 0.07; 95% CI (0.02, 0.53)) reducing the chance of success of the trial. Conclusion: Past obstetric history, such as stillbirth, history of labor trial after primary cesarean section, and prior vaginal birth, were significant predictors for achieving vaginal birth after cesarean section. Antenatal care visit, and partograph follow-up were the current obstetric characteristics positively associated with the trial of labor.

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Obesityʼs Effect on a Trial of Labor After Cesarean Delivery at a Tertiary Care Center

Obstetrics and Gynecology ◽

10.1097/01.aog.0000447116.91909.b4 ◽

2014 ◽

Vol 123 ◽

pp. 139S-140S

Author(s):

Christie J. Brough ◽

Brian Brocato ◽

Giancarlo Mari

Keyword(s):

Cesarean Delivery ◽

Care Center ◽

Tertiary Care ◽

Tertiary Care Center ◽

Trial Of Labor

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Attempt at Trial of Labor After Cesarean Delivery in Late-Term Gestation with Oligohydramnios

NeoReviews ◽

10.1542/neo.19-6-e361 ◽

2018 ◽

Vol 19 (6) ◽

pp. e361-e369

Author(s):

Ashley Aluko ◽

Melissa Spiel

Keyword(s):

Cesarean Delivery ◽

Trial Of Labor

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Outcomes Associated With Trial of Labor After Cesarean Delivery

50 Studies Every Obstetrician-Gynecologist Should Know ◽

10.1093/med/9780190947088.003.0016 ◽

2021 ◽

pp. 86-91

Author(s):

Hadi Erfani ◽

Alireza A. Shamshirsaz

Keyword(s):

Cesarean Delivery ◽

Study Design ◽

Population Study ◽

Patient Population ◽

Neonatal Outcomes ◽

Clinical Scenario ◽

Trial Of Labor ◽

Maternal And Neonatal Outcomes

This article provides a summary of a prominent study in obstetrics. What are the risks of adverse maternal and neonatal outcomes associated with trial of labor after cesarean delivery? With this question, the article presents the basics of the study, including funding, location, patient population, study design, endpoints, results, and criticism and limitations. It then briefly reviews other relevant studies in the field and information and the main recommendations of the most recent practice bulletin provided by the American College of Obstetricians and Gynecologists and concludes with a relevant clinical scenario.

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