632 Clinical characteristics and obstetric outcomes of women who considered TOLAC

Abstract

To identify the characteristics of women who considered TOLAC, and to describe their pregnancy course. This was a secondary analysis of data from the PROCEED trial, a multi-centered randomized controlled trial studying the impact of a patient centered decision app on rates of TOLAC. Clinical characteristics associated with considering TOLAC were identified, and the clinical course of those who considered TOLAC was described. Among the 1470 women in the trial, 1444 had complete data available for this analysis. 821 (57%) considered TOLAC and of these 644 (45%) ultimately underwent TOLAC. Women who considered TOLAC were younger, had lower BMIs, were more likely to have had a prior vaginal delivery (VD) and to be cared for by a CNM/NP; they were less likely to have had a prior cesarean for an arrest disorder or to have medical complications (e.g., chronic HTN, gestational diabetes and pre-existing diabetes) in the current pregnancy. In multivariable regression, the associations of age, BMI, prior VD, prior CD for arrest, and care by a CNM/NP with consideration of TOLAC persisted (Table 1). Among women who considered TOLAC but ultimately underwent ERCD (n = 177), 37 (20.8%) developed a contraindication to TOLAC (breech or previa), 44 (25%) had a repeat CD rather than an indicated induction, 88 (50%) had a repeat CD rather than awaiting labor beyond a certain date/gestational age, and 8 (4.5%) requested elective repeat cesarean during labor. 462 (72%) of the women who underwent TOLAC were admitted in labor at a mean gestational age of 39. 4 weeks and a mean cervical dilation of 4.2 cm. 182 (28%) women were induced at a mean gestational age of 39.5 weeks and a cervical dilation of 1.5 cm. Of those who underwent TOLAC, 460 (71.4%) had a VBAC. Women who are eligible for TOLAC differentially consider and undergo this delivery approach depending on their history, medical conditions, and pregnancy course. This information may be useful to women as they consider the circumstances under which they would want to undergo TOLAC.