Category: Operative Obstetrics
Poster Session IV
To determine whether patients undergoing TOLAC2 are at increased risk of poor TOLAC outcomes compared to patients undergoing TOLAC with one previous cesarean delivery(TOLAC1).
Study Design:
A retrospective cohort was study conducted at a single university-affiliated medical centre characterised by a highly parous population between 2012-2022. The study group comprised patients post two caesarean deliveries who attempted TOLAC (TOLAC2). Outcomes were compared to patients undergoing TOLAC post one cesarean delivery(TOLAC1).The primary outcome was TOLAC success. Secondary outcomes were uterine rupture and combined adverse outcome(CAO) (uterine rupture, 5 minute Apgar < 7, pH < 7.1, PPH). Patients who underwent TOLAC after induction of labor were excluded from this study.
Results:
378 patients underwent TOLAC2. Outcomes were compared to 3628 patients who underwent TOLAC1. There were no significant differences in maternal age, parity, gestational age and birth weight. Rates of successful TOLAC were 80.8% and 92.5% respectively. Patients attempting TOLAC2 were more likely to fail TOLAC than TOLAC1(19.2%Vs.7.5% OR 2.2 95 CI 2.2-3.9 p< 0.001).However, there were no significant differences in the rate of uterine rupture (0.8%Vs0.2% OR 4.1 95% CI 1.1-15.9 p=0.06) or CAO (4.2% Vs 4.8% OR 0.88 95% CI 0.5-1.5 p=0.7). Subgroup analysis of 100 patients who underwent TOLAC2 with no VBAC(26.5%) revealed a higher rate of failed TOLAC (39.8%Vs.11.5% OR 5.1 95%CI 2.9-8.7 p=0.00) and uterine rupture (3% Vs. 0% p=0.02)compared to TOLAC2 with a previous VBAC. There were no differences in the rate of CAO (3.9% Vs. 4.3% OR 0.9 95%CI 0.3-2.8 p 0.5). Patients undergoing TOLAC2 with no previous VBAC had higher rates of failed TOLAC (39.8%Vs 9.5% OR 6.3 95%CI 4.1-9.7 p< 0.001) and uterine rupture (2.9% Vs 0.3% OR 10.1 95%CI 2.2-45.7 p=0.01) compared to patients undergoing TOLAC1 with no VBAC. There were no differences in the rate of CAO (3.9% Vs 4.2% OR 0.9 95% CI 0.3-2.5 p=0.5).
Conclusion:
TOLAC after 2 previous cesarean deliveries and a previous VBAC is associated with a high chance of success and low risk of adverse outcomes.
Miriam Lopian, MD
Mayanei Hayeshua Medical Center
Bnei Brak, HaMerkaz, Israel
Sharon Perlman, MD
Women Hospital, Rabin Medical Center
Petach Tikva, Israel, Israel
Ronnie Cohen, MD
dr.
Mayanei Hayeshua Medical Center
Petach Tikva, HaMerkaz, Israel
Hagai Gershi, MD
Mayanei Hayeshua
Bnei Brak, HaMerkaz, Israel
Ariel Lasry, MD
Mayanei Hayeshua
Bnei Brak, HaMerkaz, Israel
Tal Ayalon, MD
Mayanei Hayeshua
Bnei Brak, HaMerkaz, Israel
Ioana Olteanu, MD
Mayanei Hayeshua Medical Center
Bnei Brak, HaMerkaz, Israel
Hadar Rosen, MD
Fetal Medicine specialist
Sheba Medical Center, Tel Hashomer
Toronto, Ontario, Canada
Ariel Many, MD,MHA
Lis Maternity Hospital, Department of Obstetrics and Gynecology, Sourasky Medical Center, Tel Aviv University
Tel Aviv, Israel, Israel
Lior Kashani Ligumsky, MD, MSCR
Mayanei Hayeshua Medical Center
Tel-Aviv, Israel, Israel