Hemostatic agents use during cesarean delivery and the risk for uterine rupture during subsequent TOLAC

Abstract

Hemostatic agents were found to be associated with post-cesarean infections in general and endometritis specifically. We aim to evaluate the association between a hemostatic agent used at the time of cesarean delivery to uterine scar rupture or dehiscence at the subsequent trial of labor. A multicenter retrospective cohort study of women who underwent their first trial of labor after cesarean delivery between 2005 and 2021. Women with a singleton pregnancy in whom a hemostatic agent was placed at the time of the index cesarean were compared to women in whom no such agent was placed. The primary outcome of this study was the rate of uterine rupture or dehiscence. Secondary outcomes were adverse maternal and neonatal outcomes. Univariate analyses were followed by multivariate analysis (adjusted Odds Ratio (aORs); [95% Confidence Interval]). During the study period, 7204 women underwent a trial of labor and met inclusion and exclusion criteria, of whom 431 (6.0%) had prior use of a hemostatic agent and 6773 (94.0%) didn't. History of the use of hemostatic agent wasn't found to be significantly associated with uterine scar rupture (0.9% vs. 0.4%, p=0.15) or dehiscence (0.9% vs. 0.5%, p=0.21). Moreover, we found no differences between the study groups in any maternal or neonatal parameter examined (Table 1). This was confirmed on multivariate analysis as well [aOR 1.95 (0.67–5.69), p = 0.22] for uterine rupture (Table 2). Amongst women undergoing a trial of labor, a history of hemostatic agent use confers no additional risk than no use. Further prospective studies in other settings to strengthen these findings are needed.View Large Image Figure ViewerDownload Hi-res image Download (PPT)