Rising trends in perinatal morbidity following trial of labor after cesarean delivery: population-based study

Abstract

We aimed to investigate trends in major maternal and neonatal morbidities following the trial of labor after Cesarean delivery (TOLAC). In this study, we evaluated the ten-year trends in maternal and neonatal morbidity following TOLAC from the vital statistics natality birth data provided by National Center for Health Statistics, Centers for Disease Control and Prevention (CDC) from January 2011 to December 2020. Trends were evaluated in the following four populations: successful Vaginal birth after Cesarean delivery (VBAC), failed TOLAC [women who underwent CD after a failed trial of labor], elective repeat CD [women with a previous history of CD delivered via CD without any attempt for vaginal birth], and total United States birth population. The Mann-Kendall test was used to assess the trend. From 2011-2020, 675,743 (70.89%) had successful VBAC, 953,115 women underwent TOLAC, and 4,596,029 women delivered via elective repeat CD. Uterine rupture was higher in failed TOLAC population with a significant inclining trend (p-value 0.004). The unplanned hysterectomy, maternal transfusion, and intensive care unit (ICU) admission following the delivery were higher in mothers who underwent elective repeat CD and failed TOLAC, with an inclining trend in recent years. Regarding neonatal morbidity, the neonatal ICU admission more frequently occurred following the failed TOLAC and elective repeat CD with a significantly increasing trend in all four populations (p-value < 0.001 for all populations). Successful VBAC has the best outcome in terms of perinatal morbidity compared to repeat elective CD and failed TOLAC. A significant rising trend has been reported following TOLAC in recent years for the major perinatal morbidities in comparison to the total United States population. Our results present vital counseling points for patients considering TOLAC; particularly those who have lower chances for successful VBAC. It also highlights the need to reassess management strategies of pregnancies undergoing TOLAC.View Large Image Figure ViewerDownload Hi-res image Download (PPT)