Trial of Labor After Two Cesarean Sections Versus Repeat Cesarean Section: A Retrospective Cohort Study [37P

Abstract

INTRODUCTION: Greater than 90% of women with a previous cesarean section in the USA deliver by repeat cesarean section and one third of hospitals no longer offer a trial of labor after cesarean section (TOLAC). We sought to assess maternal and neonatal outcomes amongst women with two prior cesarean sections who opted to undergo TOLAC versus repeat cesarean section. METHODS: This retrospective cohort study was undertaken at a community medical center from January 1st 2008 to December 31st 2018. Inclusion criteria were women with a vertex singleton gestation at term and a history of two prior cesarean sections. Exclusion criteria included a prior classical uterine incision or abdominal myomectomy, history of uterine rupture, placenta previa or invasive placentation, non-vertex presentation, or known fetal anomaly. Maternal and neonatal outcomes were assessed using Fisher exact test and Wilcoxon rank sum test. RESULTS: A total of 796 patients fulfilled study criteria. 69% of women who underwent TOLAC (N=85) had a successful vaginal delivery. There were no differences in neonatal intensive care unit admissions (5.7% vs 5.9%, P=1.0) or mean APGAR scores at one (P=.38) and five (P=.42) minutes amongst women who opted for TOLAC versus repeat cesarean section. Moreover, no difference in maternal morbidity was noted with regards to blood transfusion rates (2.3% vs 2.1%, P=.71), bowel injury (0% vs 0.1%, P=1.0), bladder injury (1.1% vs 0.1%, P=.21), immediate postpartum infection (0% vs 0.8%, P=1.0) and hysterectomy (0% vs 0.1%, P=1.0). CONCLUSION: TOLAC following two cesarean sections has comparable maternal and neonatal morbidity with repeat cesarean section.