Trial of labor after cesarean in twin gestation with no prior vaginal delivery - evidence from largest cohort reported.

Abstract

ObjectiveTo investigate trial of labor after cesarean (TOLAC) success rates in twin gestations with no prior vaginal delivery.MethodsA retrospective study of women with twin gestations who underwent a TOLAC and had no prior vaginal delivery during 2011–2020. TOLAC success and failure groups were compared.ResultsOf 675 twin gestations with a history of cesarean delivery and no prior vaginal delivery, 83 (12.3%) elected to undergo a TOLAC and 26 (31.3%) succeeded. Two (7.7%) women delivered by cesarean for the second twin after vaginal delivery of the first twin. Epidural analgesia was positively associated with TOLAC success (odds ratio [OR] 4.31, 95% confidence interval [CI] 1.56–11.94, P = 0.004). Uterine rupture occurred in two patients (3.5%) of the TOLAC failure group. The proportion of cases with low Apgar score (<7) at 5 min was higher in the TOLAC success group (4 [15.4%] versus 1 [1.8%]; OR 10.1, 95% CI 1.07–96.22, P = 0.032) and the neonatal composite adverse outcome rate was lower in this group (OR 0.22, 95% CI 0.07–0.69, P = 0.009).ConclusionTOLAC in women with twins with no prior vaginal delivery is associated with a low success rate. No independent predictors of successful TOLAC were identified.