Trial Of Labor After Cesarean Research Articles

Exploring Effect of Patient Counseling on Mode of Delivery After Cesarean Section [ID 2683575

INTRODUCTION: Increasing vaginal birth after cesarean (VBAC) may help lower national cesarean delivery rates in the United States. This study aims to evaluate factors that affect counseling practices and trial of labor after cesarean (TOLAC). METHODS: All term repeat cesarean deliveries (rCDs) and VBACs from September 2018 to February 2020 were reviewed. Antepartum counseling on mode of delivery, demographic, and obstetrical data were collected. Patients who were not TOLAC candidates were excluded. This study was IRB approved. RESULTS: Six hundred thirty-five patients met inclusion criteria. 304 (47.72%) of these patients had rCD, 65 (10.20%) attempted TOLAC with subsequent rCD, and 268 (42.07%) had VBAC. Of the 635 patients, 470 (74.02%) patients had documentation of TOLAC counseling prior to admission for delivery, whereas 165 (25.98%) did not. TOLAC counseling documentation was not associated with age, race, ethnicity, body mass index (BMI), insurance type, or history of vaginal delivery (VD). Prior VBAC increased the odds of documented TOLAC counseling (odds ratio [OR] 2.36; 95% CI, 1.29–4.63). Medicaid insurance (OR 2.18; 95% CI, 1.29–3.73), history of VD (OR 2.28; 95% CI, 1.16–4.68), history of VBAC (OR 269.0; 95% CI, 50.2–5079), and documented TOLAC counseling (OR 21.12; 95% CI, 11.0–45.10) increased the odds of TOLAC. Increasing BMI decreased the odds of TOLAC (OR 0.91; 95% CI, 0.89–0.95). CONCLUSION: Documented TOLAC counseling increased the odds of attempting TOLAC. As only 74.02% of patients had documented counseling prior to admission for delivery, an effort to increase TOLAC counseling and documentation may increase TOLAC and subsequent VBAC rates, decreasing the cesarean delivery rate.

Examining provider practice-level disparities in delivery outcomes among patients with a history of Cesarean Delivery

BackgroundChoosing whether to pursue a trial of labor after cesarean (TOLAC) or scheduled repeat cesarean delivery (SRCD) requires prenatal assessment of risks and benefits. Providers and patients play a central role in this process. However, the influence of provider-associated characteristics on delivery methods remains unclear. We hypothesized that different provider practice groups have different obstetric outcomes in patients with one prior cesarean delivery (CD).MethodsThis was a retrospective cohort study of deliveries between April 29, 2015 – April 29, 2020. Subjects were divided into three cohorts: SRCD, successful VBAC, and unsuccessful VBAC (patients who chose TOLAC but had a CD). Disparities were reviewed between five different obstetric provider practice groups, determined from a breakdown of different providers delivering at the study site during the study period. Proportional differences were examined using Chi-squared tests and logistic regression models.Results1,439 deliveries were included in the study. There were significant proportional disparities between patients in the different groups. Specifically, patients from Group D were significantly more likely to undergo successful VBAC, while patients seeing a provider from Group A were more likely to deliver by SRCD. In our multivariate analysis of successful versus unsuccessful VBAC, patients from Group D had greater odds ratios of successful VBAC compared to Group A. Patients delivered by Group E had a significantly lower odds ratio of successful VBAC.ConclusionThis study suggests an association between provider practice groups and delivery outcomes among patients with one prior CD. These data contribute to a growing body of literature around patient choice in pregnancy and the interplay of patients and providers. These findings help to guide future investigations to improve outcomes among patients with a history of CD.

Trial of Labor versus Repeat Cesarean Delivery in Individuals with Morbid Obesity after Previous Cesarean Delivery.

This study aimed to compare adverse neonatal outcomes associated with the trial of labor after cesarean (TOLAC) at term in pregnancies according to maternal prepregnancy body mass index (BMI; kg/m2) and the presence of previous vaginal delivery (VD). This was a repeated cross-sectional analysis of individuals with singleton, cephalic, and term deliveries with a history of one or two cesarean deliveries in the Linked Birth/Infant Death data from 2011 to 2020. Outcomes were examined according to the BMI category including BMI <30, 30 to 39.9, and 40 to 69.9 kg/m2. The primary outcome was a composite neonatal outcome, defined as any presence of neonatal death, neonatal intensive care unit admission, assisted ventilation, surfactant therapy, or seizures. Outcomes were compared between TOLAC and elective repeat cesarean delivery (eRCD) after stratifying by BMI category and previous VD. Log-binomial regression was performed to obtain adjusted relative risk (aRR) with 99% confidence intervals, controlling for covariates. Of 4,055,440 individuals, 2,627,131 had BMI <30 kg/m2, 1,108,278 had BMI 30 to 39.9 kg/m2, and 320,031 had BMI 40 to 69.9 kg/m2. In individuals with no previous VD, VD rates after TOLAC were 66.7, 57.2, and 48.1%, respectively. In individuals with previous VD, VD rates after TOLAC were 81.4, 74.7, and 67.3%, respectively. In individuals without previous VD, compared with those who had an eRCD, those who had TOLAC were more likely to experience composite neonatal outcomes in individuals with BMI < 30 kg/m2 (5.0 vs. 6.5%; aRR 1.33 [1.30-1.36]), BMI 30 to 39.9 kg/m2 (6.1 vs. 7.8%; aRR 1.29 [1.24-1.34]), and BMI 40 to 69.9 kg/m2 (8.2 vs. 9.0%; aRR 1.15 [1.07-1.23]). In individuals with previous VD, there was no difference in the composite neonatal outcomes in BMI < 30 kg/m2 (6.2 vs. 5.8%; aRR 0.98 [0.96-1.00]), BMI 30 to 39.9 kg/m2 (7.4 vs. 7.1%; aRR 0.99 [0.95-1.02]), and BMI 40 to 69.9 kg/m2 (9.4 vs. 8.7%; aRR 0.96 [0.91-1.02]). TOLAC among obese individuals could be offered in selected cases. · TOLAC among obese individuals could be offered selectively, despite their reduced likelihood of attempting or succeeding at it.. · Higher BMI individuals show decreased rates of both attempting and achieving successful TOLAC.. · Despite these trends, attempting TOLAC after a previous vaginal delivery does not heighten neonatal complications..

Exploring Vaginal Birth After Cesarean: Success Rates and Cultural Decisions in the United Arab Emirates.

This study explores the success rates and cultural influences on the decision-making process for vaginal birth after cesarean (VBAC) in the United Arab Emirates (UAE). An observational cohort study was conducted at a hospital in the UAE accredited by Joint Commission International, enrolling 263 women eligible for VBAC from March 1, 2018, to February 28, 2019. The study focused on maternal-fetal outcomes, the proportions of women opting for trial of labor after cesarean (TOLAC) versus elective repeat cesarean section (ERCS), and the impact of cultural backgrounds on these decisions. The study found significant cultural variations in VBAC acceptance and success rates. Among local Emirati/Omani women, 86% (152 out of 177) opted for TOLAC, with an 83% success rate (126 out of 152). In contrast, lower TOLAC uptake and success rates were observed among other nationalities, such as Egyptian and other Arab women. The study also noted higher VBAC success rates in women with prior vaginal deliveries and those who experienced spontaneous labor. NICU admissions and maternal readmissions were lower in the TOLAC group (1% NICU admissions and 2% maternal readmissions) compared to the ERCS group (8.2% NICU admissions). The study underscores the influence of cultural factors in VBAC decision-making and outcomes, highlighting the need for culturally tailored counseling and care. It also confirms the safety and efficacy of VBAC in appropriately selected cases, advocating for more research into counseling practices and long-term outcomes in culturally diverse populations. Impact statement: This research adds to the understanding of how cultural and ethnic backgrounds influence VBAC decisions and outcomes, offering critical insights for clinical practice, especially in multicultural societies like the UAE. It emphasizes the role of tailored counseling and suggests avenues for future research in this domain.

The impact of a trial of labor after cesarean versus elective repeat cesarean delivery: A meta-analysis.

The increasing global incidence of cesarean section has prompted efforts to reduce cesarean delivery rates. A trial of labor after cesarean (TOLAC) has emerged as an alternative to elective repeat cesarean delivery (ERCD) for women with a prior cesarean delivery. However, the available evidence on the comparative outcomes of these 2 options remains inconsistent, primarily due to varying advantages and risks associated with each. Our meta-analysis aims to compare the maternal-neonatal results in TOLAC and ERCD in women with prior cesarean deliveries. A comprehensive search was performed in PubMed, Embase, Cochrane library databases up to September,2022 to identity studies evaluating perinatal outcomes in women who underwent TOLAC compared to ERCD following a previous cesarean delivery. The included studies were subjected to meta-analysis using RevMan 5.3 software to assess the overall findings. A total of 13 articles were included in this meta-analysis. Statistically significant differences were identified in the rate of uterine rupture (OR = 2.01,95%CI = 1.48-2.74, P < .00001) and APGAR score < 7 at 5 minutes (OR = 2.17,95%CI = 1.69-2.77, P < .00001) between the TOLAC and ERCD groups. However, no significant differences were observed in the rates of hysterectomy, maternal blood transfusion, postpartum infection, postpartum hemorrhage and neonatal intensive care unit (P ≥ .05) admission between the 2 groups. Our analysis revealed that TOLAC is associated with a higher risk of uterine rupture and lower incidence APGAR score < 7 at 5 minutes compared to ERCD. It is vital to consider predictive factors when determining the appropriate mode of delivery in order to ensure optimal pregnancy outcomes. Efforts should be made to identify the underlying causes of adverse outcomes and implement safety precautions to select suitable participants and create safe environments for TOLAC.

Incidence and Predictors of Successful Vaginal Birth Among Women With a History of Cesarean Section in Public Health Facilities of Southern Ethiopia in 2021

BACKGROUND:Even though a cesarean section (CS) performed greater than 15% has no significant association with a reduction in maternal and neonatal mortality, repeat elective CS continues to play a major role in unnecessary CS worldwide. Trial of labor after cesarean (TOLAC) is one of the strategies to reduce the rate of unnecessary CS. However, the selection of candidates for a TOLAC is not an easy task without evidence. This study was conducted to determine the incidence of successful vaginal birth after one CS and the associated factors in public health facilities in southern Ethiopia.METHODS:An institutional-based cross-sectional study was conducted from June 10, 2020, to December 10, 2021, on laboring women, and the data were collected using a pretested interviewer-administered questionnaire and a data extraction sheet. A binary logistic regression model was used to assess the factors associated with successful vaginal birth after cesarean (VBAC) section using SPSS version 25. Bivariate and multivariate analyses were performed, and independent variables withp&lt; .05 along with an odd ratio and 95% confidence interval (CI) declare the associated factors.RESULTS:A total of 417 women participated in this study making a response rate of 98.8%. The incidence of vaginal births after cesarean was 51.1% (CI, 46%–56%). The likelihood of successful VBAC was observed in women with a history of vaginal delivery before CS (AOR, 3.7, CI = 1.06, 13.19), favorable Bishop score at admission (AOR, 19.1, CI = 2.69, 134.98), greater than 4-cm cervical dilation at admission (AOR, 171.3, CI = 1.8, 16,722), and clear color of amniotic fluid (AOR, .096, CI = .02, .38).CONCLUSION:The incidence of VBAC in this study is promising and should be practiced. In choosing a woman for the TOLAC, health professionals might need to pay attention to intrapartum variables, such as cervical dilation, Bishop score, and color of the amniotic fluid.

Perinatal outcomes following uterine rupture during a trial of labor after cesarean: A 12-year single-center experience.

To determine perinatal outcomes following uterine rupture during a trial of labor after one previous cesarean delivery (CD) at term. A retrospective single-center study examining perinatal outcomes in women with term singleton pregnancies with one prior CD, who underwent a trial of labor after cesarean (TOLAC) and were diagnosed with uterine rupture, between 2011 and 2022. The primary outcome was a composite maternal outcome, and the secondary outcome was a composite neonatal outcome. Additionally, we compared perinatal outcomes between patients receiving oxytocin during labor with those who did not. Overall, 6873 women attempted a TOLAC, and 116 were diagnosed with uterine rupture. Among them, 63 (54.3%) met the inclusion criteria, and 18 (28%) had the maternal composite outcome, with no cases of maternal death. Sixteen cases (25.4%) had the composite neonatal outcome, with one case (1.6%) of perinatal death. No differences were noted between women receiving oxytocin and those not receiving oxytocin in the rates of maternal composite (35.7% vs 26.5%, P = 0.502, respectively) or neonatal composite outcomes (21.4% vs 26.5%, P = 0.699). Uterine rupture during a TOLAC entails increased risk for myriad adverse outcomes for the mother and neonate, though possibly more favorable than previously described. Oxytocin use does not affect these risks.

Mid-trimester cervical length and prediction of vaginal birth after cesarean delivery in Chinese parturients: A retrospective study

BackgroundA successful trial of labor after cesarean (TOLAC) is linked with the best maternal/neonatal outcomes and is more cost-effective than elective repeat cesarean section (ERCS). Predictive models of vaginal birth after cesarean (VBAC) have been established worldwide to improve the success rate of TOLAC. ObjectiveTo validate a VBAC prediction model (the updated Grobman's predictive model without ethnicity) and identify whether mid-trimester cervical lengths (MCL) improve the prediction of VBAC among Chinese women undergoing a TOLAC. MethodsIn this retrospective cohort study, the inclusion criteria were a previous history of cesarean delivery (CD) as well as a singleton gestation in the vertex position with routine CL measurements between 20 and 24 weeks and the experience of a TOLAC. MCL as well as identifiable characteristics in early prenatal care that have been used in updated Grobman's predictive model (maternal age, height, pre-pregnancy weight, vaginal delivery history, VBAC history, arrest disorder in previous CD, and treated chronic hypertension) were obtained from the medical records. Associations of maternal characteristics and MCL with VBAC were evaluated using multivariate logistic regression. Two multivariable regression models with and without MCL as one of the risk factors were established and their predictive accuracy for VBAC was critically compared based on receiver-operating characteristic (ROC) curves. ResultsThis study involved 409 women, among which, 347 (84.8%) achieved a VBAC. The mean MCL was significantly shorter in women who had a successful VBAC than in those who required an intrapartum CD (4.16±0.49 cm vs. 4.35±0.46 cm, P=0.007). Multivariable logistic regression revealed that a longer MCL (cm) was significantly related to a lower success rate of TOLAC [adjusted odds ratio (aOR), 0.48; 95% confidence interval (CI), 0.26−0.88]. The areas under the ROCs of Grobman's model with and without MCL as one of the risk factors were 0.785 (95% CI, 0.725−0.844) and 0.774 (95% CI, 0.710−0.837), respectively, but not significantly different (Z = −0.968, P = 0.333). ConclusionsWe first evaluated the efficiency of the updated Grobman's model (without race and ethnicity) in the Chinese population. The area under the curve is relatively high, indicating that the model can be used efficiently in China. The shorter MCL was associated with a greater chance of VBAC and MCL was the independent factor from the factors of Grobman's model. However, the predictive capacity of the modified model by adding MCL as one of the risk factors did not improve significantly.

Preferred mode of delivery and its associated factors in pregnant women with a previous cesarean scar at a tertiary care hospital in Ethiopia: institutional-based cross-sectional study

BackgroundVaginal births after cesarean or elective repeat cesarean sections (CS) are the options for delivery after one cesarean scar. However, there is a lack of data regarding the preferred next mode of delivery in Ethiopia after a previous cesarean section. Thus, this study assessed the preferred mode of delivery and determinants after one previous CS in the antenatal clinic at the University of Gondar Comprehensive Specialized Hospital (UoGCSH).MethodsAn institutional-based cross-sectional study was conducted among pregnant mothers with one previous CS at UoGCSH from March to August 2022. Structured questionnaires were used to collect the data. The collected data were entered, cleaned, and edited using Epi-data 4.6 and exported to SPSS version 26 for analysis. A binary logistic regression was performed to assess the determinants of the preferred mode of delivery. A p-value of < 0.05 at the 95% confidence level (CI) was considered statistically significant.ResultsThe majority, 71.5% (95% CI: 64.7, 77.1), of participants preferred the trial of labor after cesarean (TOLAC) as their mode of delivery. Mothers who were married (AOR = 4.47, 95% CI: 1.19–16.85), had a diploma educational level (AOR = 3.77, 95% CI: 1.84–12.36), had previous post-cesarean complications (AOR = 3.25, 95% CI: 1.08–9.74), and knew about the success of the trial of labor after cesarean (AOR = 13.56, 95% CI: 4.52–37.19) were found to prefer the trial of labor compared with their counterparts.ConclusionThis study concluded that most pregnant mothers preferred labor trials after one CS, which is a bit lower but comparable with recommended practice guidelines. Providing adequate information and counseling mothers to make informed decisions about their preferred mode of delivery could be substantial.

Effect of excessive gestational weight gain before and after 28 weeks on trial of labor after cesarean stratified by pre-pregnancy body mass index: a retrospective cohort study.

This study aimed to assess the effect of excessive gestational weight gain (GWG) before and after 28 weeks on the mode of delivery in women who attempted a trial of labor after cesarean (TOLAC), stratified by pre-pregnancy BMI. A retrospective analysis of the outcomes of eligible women who attempted trial of labor after cesarean (TOLAC) in a Chinese hospital from January 2016 to October 2022 was performed. GWG before and after 28 weeks was categorized as 'excessive' or 'non-excessive' based on the guideline of Institute of Medicine (IOM). Multivariable logistic regression analyses were used to estimate the effect of excessive GWG before and after 28 weeks on mode of delivery in women who underwent TOLAC, stratified by pre-pregnancy BMI. Of the 512 women who underwent term trial of labor, 71.1% achieved a vaginal birth. No correlation was found between excessive GWG before 28 weeks and the rate of vaginal birth after cesarean (VBAC). Among women with or without excessive GWG before 28 weeks, excessive GWG after 28 weeks was significantly associated with a reduced rate of VBAC. When stratified by pre-pregnancy BMI, women who had excessive gestational weight gain after 28 weeks gestation had lower rates of VBAC than those who did not, regardless of being underweight, normal or overweight (aOR 0.23, 95% CI 0.06-0.88; aOR 0.42, 95% CI 0.25, 0.70; and aOR 0.12, 95% CI 0.04-0.36; respectively). Excessive weight gain after 28 weeks of pregnancy was related to decreased rates of VBAC, irrespective of pre-pregnancy weight status and weight gain before 28 weeks.

Predictive Efficacy of the FLAMM Calculator in Assessing Successful Trial of Labor after Cesarean (TOLAC)

Predictive Efficacy of the FLAMM Calculator in Assessing Successful Trial of Labor after Cesarean (TOLAC)

Comparing Cesarean Birth Utilization Between US Hospitals: A Demonstration of the Robson Ten-Group Classification System for Use in Quality Improvement and Benchmarking.

The World Health Organization-endorsed Robson Ten-Group Classification System (TGCS) is a standard reporting mechanism for cesarean birth, yet this approach is not widely adopted in the United States. To describe the application and utility of the TGCS to compare hospital-level cesarean births rates, for use in quality improvement and benchmarking. We conducted a descriptive, secondary data analysis of the Consortium on Safe Labor dataset using data from 228 438 women's births, from 2002 to 2008, in 12 sites across the United States. We stratified births into 10 mutually exclusive groups and calculated within-group proportions of group size and cesarean birth rates for between-hospital comparisons of cesarean birth, trial of labor after cesarean (TOLAC), and labor induction utilization. There is variation in use of cesarean birth, labor induction, and TOLAC across the 12 sites. The TGCS provides a method for between-hospital comparisons, particularly for revealing usage patterns of labor induction, TOLAC, and cesarean birth. Adoption of the TGCS in the United States would provide organizations and quality improvement leaders with an effective benchmarking tool to assist in reducing the use of cesarean birth and increasing the support of TOLAC.

Family support and the healthcare workforce when the patient chooses a cesarean section on maternal and neonatal outcomes

Background: Childbirth is a series of pregnancy processes that end with the expulsion of the products of conception. The number of births with SC is increasing every year. In Indonesia, the incidence of cesarean section in 2009 has reached 29.6%. This number certainly affects the mortality and morbidity rates in subsequent deliveries.Purpose: To identify family support and the healthcare workforce when the patient chooses a cesarean section on maternal and neonatal outcomesMethod: A case study with TOLAC (Trial of Labor After Cesarean Delivery) is a planned effort to give birth vaginally by a woman who has had a previous SC delivery. Women's perceptions related to pregnancy to delivery can influence the choice of the desired delivery method.Results: Women 31 year old with G3P1011 assisted since 17-18 weeks of gestation. Had an obstetric history with 1x caesarean section in 2016 because there was no progress in labour. Early referral planning has been carried out. Termination of pregnancy by sectio caesarea is planned at 38-39 weeks of gestation. Since the beginning of the pregnancy, the mother wanted to give birth vaginally, but the mother did not get support from her husband or family. Before the intervention was carried out, the mother experienced signs of labor and the mother wanted to try vaginal delivery but was not supported by healthcare workforce and a cito SC was performed. The baby was born healthy with a good Apgar score.Conclusion: The perceptions and beliefs that pregnant women have after SC surgery need to be balanced with the support of their families and healthcare workforce so that they are successful in undergoing trials of the normal delivery method according to preference. Mentoring activities can be a method of providing education, monitoring efforts, and early detection of complications in pregnant women with former SC operations.

Trial of labour versus elective caesarean delivery for estimated large for gestational age foetuses after prior caesarean delivery: a multicenter retrospective study

BackgroundLower rates of successful trial of labor after cesarean (TOLAC) in association with fetal macrosomia were previously reported. This study aimed to compare TOLAC to elective caesarean delivery (CD) in women with estimated fetal weight large for gestational age (eLGA) and a prior CD. Primary outcome was to analyse the mode of delivery in case of TOLAC. Secondary outcome was to compare maternal and foetal morbidity.MethodsWe conducted a retrospective, descriptive, multicentric, cohort study in five maternity units between January and December 2020. Inclusion criteria were: women with a single prior CD and eLGA or neonatal weight > 90th percentile with singleton pregnancy and gestational age ≥ 37 weeks. Main outcome measures: rate of vaginal delivery, maternal and fetal morbidity including: shoulder dystocia, neonatal hospitalization, fetal trauma, neonatal acidosis, uterine rupture, 3rd and 4th perineal tears, post-partum hemorrhage, and a need for blood transfusion.ResultsFour hundred forty women met inclusion criteria, including 235 (53.4%) eLGA. 170 (72.3%) had a TOLAC (study group) and 65 (27.7%) an elective CD (control). 117 (68.82%) TOLAC had a vaginal delivery. No significant differences were found between the two groups in the rates of: postpartum haemorrhage, transfusion, Apgar score, neonatal hospitalization, and foetal trauma. Cord lactate was higher in the case of TOLAC (3.2 vs 2.2, p < 0.001). Median fetal weight was 3815 g (3597–4085) vs. 3865 g (3659–4168): p = 0.068 in the study vs. controls group respectively.ConclusionTOLAC for eLGA fetuses is legitimate because there is no difference in maternal–fetal morbidity, and the CD rate is acceptable.

Effect of Prior Cesarean Section Delivery on Intrapartum Cesarean Section Outcomes [ID: 1372249

INTRODUCTION: Intrapartum cesarean deliveries (CDs) are associated with higher rates of maternal and neonatal morbidity than scheduled CDs. In patients undergoing trial of labor after cesarean (TOLAC), perceived added difficulty of intrapartum CD may influence provider decisions on labor management. We sought to evaluate the effect of prior CD on operative times and maternal/neonatal outcomes among those undergoing intrapartum CD. METHODS: This is a retrospective cohort study of all singleton, nonanomalous fetuses delivered by intrapartum CD at a tertiary care center from June 2018 to April 2019. CD was categorized as intrapartum if it occurred after the patient was admitted in spontaneous labor or received an induction agent. The primary outcome was time from skin incision to delivery. Secondary outcomes were composite measures of maternal (postpartum hemorrhage, bowel or bladder injury, transfusion, endomyometritis, intensive care unit admission, readmission, wound complications) and neonatal (neonatal intensive care unit admission, respiratory support, therapeutic hypothermia, neonatal mortality, and fetal acidemia) morbidity. We compared these outcomes between women with and without history of prior CD. Multivariable logistic regression was used to control for potential confounders. RESULTS: Of 374 intrapartum CDs, 270 (72%) were in patients without prior cesarean section and 104 (28%) were in patients undergoing TOLAC. Operative times were significantly longer in women with a prior CD including time from skin incision to delivery (9 [interquartile range (IQR) 7–13] versus 6 minutes [IQR 3–8], P&lt;.001) and total procedure time (63 [IQR 52–79] versus 55 minutes [IQR 45–65], P&lt;.001). Composite maternal (adjusted relative risk [aRR] 1.04, 95% CI 0.62–1.74) and neonatal (aRR 1.01, 95% CI 0.63–1.64) morbidity did not differ between groups. CONCLUSION: Although associated with longer operative times, history of a prior CD does not significantly increase maternal or neonatal morbidity among women undergoing intrapartum CD. Therefore, the threshold to perform an intrapartum CD in those undergoing TOLAC should be similar to those without a prior CD.

MODE OF DELIVERY IN THE SECOND PREGNANCY OF MOTHER WITH HIGH MYOPIA AND HISTORY OF SECTIO CESAREAN: A CASE REPORT

Background: Pregnant women with a history of cesarean section have problems choosing the delivery method for their next pregnancy. Sometimes there are still other risk factors, one of which is high myopia, which adds to the problem of choosing an effective delivery method with the advantages and disadvantages of each. Continuity of care in midwifery is very important in providing patients insight, knowledge, and support to make decisions about appropriate and safe delivery methods. Case report: A 29-year-old woman G2P1A0 with high myopia (minus 8) and cesarean scar three years ago for indications of high myopia (minus 10). In this second pregnancy, the mother underwent another SC because of high myopia minus 8, and the mother has not had a retinal laser until the present. Patients receive referrals from a primary health center for antenatal care and preparation for delivery at referral health facilities with high-risk pregnancies. Mothers are faced with two choices: TOLAC (Trial Of Labor After Cesarean Delivery) and ERCD (Elective Repeat Cesarean Delivery). The mother was consulted by an eye specialist at the referral hospital. The condition of the eye’s retina is good from the results of an eye specialist examination. However, it is still necessary to do a retinal laser process as prophylaxis if the mother wants to have a vaginal delivery. In the end, cesarean delivery is the mother's choice. Conclusion: Pregnancies with high myopia and cesarean scars need to receive full support from midwives and families to carry out comprehensive COC care to improve the health of mothers and children by assisting mothers in selecting delivery methods that are effective and safe for both mother and baby.&#x0D;

Prediction of vaginal birth after cesarean in China.

This study aimed to develop and validate a prediction model of vaginal birth after cesarean delivery (VBAC) in China. A nomogram for effective prediction of VBAC of singleton, cephalic and one previous low-transverse cesarean section deliveries was created by comparing the combinations of ultrasonographic and non-ultrasonographic factors from five hospitals between 2018 and 2019. A total of 1066 women were included. Of the women who underwent trial of labor after cesarean (TOLAC), 854 (80.1%) had a VBAC. Ultrasound factors included reached a higher area under the curve (AUC) combined with non-ultrasonographic factors. Of the three ultrasonographic factors analyzed, the best predictive factor for successful TOLAC was fetal abdominal circumference. A nomogram was generated with eight validated factors, including maternal age, gestational week, height, previous vaginal delivery, Bishop score, dilatation of the cervix at the time of admission, body mass index at delivery, and fetal abdominal circumference by ultrasound. The trained and validated AUC were 0.719 (95% confident interval 0.674-0.764) and 0.774 (95% confident interval 0.712-0.837), respectively. Our VBAC nomogram based on obstetric factors and fetal abdominal circumference obtained by ultrasound could be used to counsel women who are considering TOLAC.

EVALUATING THE SUCCESS RATE OF VAGINAL DELIVERY AFTER CAESAREAN SECTION

: The retrospective study was conducted in the Department of Gynecology Dr. Ruth K. M. Pfau Civil Hospital Karachi, from February 2021 to February 2022, for the evaluation of factors associated with the success of TOLAC (trial of labor after cesarean delivery) and to identify variables for predicting the success of TOLAC in subjects with prior Caesarean section (CS). A total of 315 women were included in the study. They were divided into the validation cohort (n=20, 63%) and the training cohort(n=295, 93.6%). The primary endpoint was the success rate of vaginal delivery. The results showed that of 315 participants, 264 (83.8%) women had successful TOLAC and vaginal delivery, and 51 (16.1%) had ERCS. According to multivariate analysis, BMI-estimated birth weight, gestational age &lt;41 weeks, rupture of membranes, and cervix Bishop score ≥5 was significantly associated with the success of TOLAC. Results suggest that TOLAC has a high success rate in women with a history of c-sections.

Decreasing urgent repeat cesarean sections by offering complimentary ultrasounds and consultation in rural Burundi: The zigama mama project.

Repeat urgent cesarean sections (CS) carry an increased risk of severe maternal outcomes. As CS increase in sub-Saharan Africa, creative strategies are necessary to reduce the rate of urgent repeat CS. The Zigama-Mama Project in rural Burundi uses complimentary ultrasounds to create a clinical touchpoint to counsel women with a prior CS for a hospital-based delivery. From July 2019 to June 2020, complimentary ultrasounds were offered to all antenatal patients with prior CS, along with counseling for monitored trial of labor after cesarean (TOLAC) or scheduled repeat CS. Community engagement and feedback from district health centers were evaluated. In total, 500 women with a prior CS presented for a complimentary ultrasound. During the intervention year, a relative and absolute reduction in urgent repeat CS (baseline: n = 114 {70.8%}, intervention: n = 97{49.7%}, p < 0.001) was observed, with no significant change in maternal mortality or ruptured uteri. All health center personnel agreed the project improved their confidence in referring women with prior CS. Offering complimentary ultrasounds as a clinical touchpoint for scheduling a monitored delivery or CS for women at high risk for delivery complication may be an affordable and creative strategy to care for women with previous CS during subsequent deliveries.

A successful vaginal birth after cesarean in a patient with uterine didelphys

Abstract Objectives With increasing rates of cesarean delivery across the United States, a trial of labor after cesarean (TOLAC) is a reasonable alternative for qualified candidates. Although Müllerian anomalies are associated with a variety of adverse pregnancy outcomes, there is little existing data regarding TOLAC in these patients. We present a case of a patient with a didelphys uterus who achieved a successful vaginal birth after cesarean section (VBAC) in the setting of labor augmentation. Case presentation Our patient is a 32-year-old G4P1021 (Gravida 4 Para 1,021–1 term delivery, 0 preterm deliveries, 2 abortions, 1 living offspring) who presented at 8 weeks of gestation with a known history of a didelphys uterus. Her obstetrical history was significant for a prior low-transverse cesarean section at term. All four of her pregnancies were located in the right uterine horn. At 39 weeks 3 days of gestation she presented in early labor and requested a TOLAC. She received an epidural, a cervical ripening balloon was placed, and she was started on pitocin. She pushed to deliver a viable infant. The patient’s postpartum course was uncomplicated, and she was discharged home on postpartum day two. Conclusions Müllerian anomalies are associated with several poor pregnancy outcomes including increased rates of PPROM, preterm delivery, FGR, and malpresentation necessitating a cesarean section. Our patient required augmentation of her labor but was ultimately able to achieve a successful VBAC with a healthy neonate. She represents an understudied population of patients with uterine anomalies who not only can have favorable pregnancy outcomes but may even be able to safely achieve a VBAC.