Maternal Outcomes of Trial of Labor After Cesarean Delivery Compared With Elective Repeat Cesarean Delivery [23P

Abstract

INTRODUCTION: The vaginal birth after cesarean (VBAC) calculator developed by the MFMU Network helps to identify the likelihood of VBAC. It is not clear if undergoing a trial of labor after cesarean section (TOLAC) is associated with adverse maternal outcomes if the VBAC success rate is low. We compared maternal outcomes of TOLAC to those of elective repeat cesarean delivery after stratifying by the VBAC likelihood. METHODS: This was a retrospective cohort study of all women whose primary cesarean delivery and subsequent singleton delivery occurred at our academic center. Data from the second pregnancy were analyzed. The likelihood of VBAC success was categorized using the MFMU VBAC calculator, (less than 60% and 60–100%). The primary outcome was a composite of maternal complications (uterine rupture, postpartum hemorrhage). Multivariable logistic regression was used to calculate adjusted odds ratio (OR) and 95% confidence interval (CI). RESULTS: Of 626 women, 469 (75%) and 157 (25%) had VBAC likelihood of 60–100% and less than 60%, respectively. Women with VBAC likelihood less than 60% and likelihood of 60–100% who had underwent TOLAC were compared with those who had an elective repeat cesarean. Both groups had similar rates of the primary outcomes; likelihood less than 60% (25% vs. 16.5%; adjusted OR 1.51 [95% CI 0.60–3.78]) and likelihood 60–100% (14.3% vs 13.8%; adjusted OR 1.04 [95% CI 0.60–1.79]). CONCLUSION: Women with a history of a primary cesarean delivery, who underwent TOLAC compared to those who had an elective repeat cesarean had similar odds of maternal adverse outcomes regardless of the VBAC likelihood.