Abstract
TOLAC attempts are constantly declining due to doctors' and patients' concern of failure complications. We aim to compare characteristics and perinatal complications of women undergoing urgent cesarean delivery (CD) due to failure of TOLAC (f-TOLAC) vs. intrapartum primary cesarean section A retrospective cohort study in a single center with strict TOLAC protocol, 2006-2014. Data from computerized records database. Excluded: preterm delivery, multiple gestation, TOLAC decline ad hoc. Maternal and neonatal outcomes are reported. Multivariate regression adjusted for covariates/mediators. During the study period 126,693 deliveries occurred with an overall CD rate of 11.7%. Women who experienced f- TOLAC were significantly older, of higher parity, experienced more previous vaginal deliveries, had lower rates of pregnancy hypertensive complications labor induction. f-TOLAC was associated with significantly higher rates of: uterine rupture, blood products transfusion and peripartum re-laparotomy (1.95% vs 0.004%, p<0.0001, 5.5% vs 2%, p<0.0001 and 1.3% vs. 0.0%, <0.0001, respectively). Primary intrapartum cesarean was associated with higher rates of: neonatal NICU admission (7.5% vs. 5%, p=0.014), prolonged maternal hospitalization (55.4% vs 49.4%, p=0.005) and Hb drop>3g/dL (22.4% vs. 18.8%, p=0.03). The rates of early postpartum hemorrhage, 5' Apgar <7 and maternal re-admission within 6 weeks were comparable in both groups. (19.7% vs. 18.8%, 3.4% vs 2.9%, p=0.523p=0.55 and 1.6% vs. 1.3%, p=0.653, respectively Adjusted for covariates, primary urgent CD compared to failed TOLAC, is associated with higher overall maternal morbidity: OR=1.43 95%CI[1.19-1.70] , p<0.0001. Failure of TOLAC which was managed by strict criteria and supervision is associated with lower overall maternal morbidity and no additional neonatal morbidity as compared to primary in labor CD. This data should be in mind while consulting women with previous cesarean about mode of delivery on their next pregnancy.
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