Category: Operative Obstetrics
Poster Session IV
A retrospective cohort study was conducted at a single university-affiliated medical centre between the years 2012-2018. Patients who underwent a TOLAC attempt after a successful ECV comprised the study group. Outcomes were compared to patients who underwent TOLAC in a vertex presentation without a history of ECV. The primary outcome was TOLAC success. Secondary outcomes included mode of delivery and adverse neonatal outcomes including 5 minute Apgar score < 7, umbilical cord pH < 7.1. Patients undergoing TOLAC with a history of 2 previous cesarean deliveries were excluded from this study.
Results:
7693 patients underwent a TOLAC attempt during the study period. 66 patients had a successful ECV and comprised the study group. Outcomes were compared to 7627 patients undergoing TOLAC who did not have an ECV. There were no significant between-group differences in maternal age (31.6± 4.6 Vs 32.4± 5.3, p< 0.19), parity (4.3±2.4 Vs 4.4±2.6 p=0.81 ), gestational age at delivery (39.4±1.2 Vs 39.4±1.4 p=0.51) or birthweight (3338.0±440.9 Vs 3364.9±442.1 p=0.69). Patients who underwent ECV were just as likely to have a successful TOLAC (87.9% Vs 93.5% OR 0.49 95%CI 0.25-1.12 p=0.07) and did not have an increased risk of operative vaginal delivery (13.6% Vs 8.4% OR 1.74 95% CI 0.8-3.4 p=0.13), 5 minute APGAR score < 7 (0% Vs 0.4% OR 0.16 95% CI 0.03-1.8 p=1.0) or umbilical cord pH < 7.1 (1.5% Vs 0.2% OR 7.6 95% CI 0.3-39.8 p=0.15) compared to the control group.
Conclusion: TOLAC after a successful ECV is associated with a high rate of vaginal birth after cesarean (VBAC) without an increased risk of adverse neonatal outcomes.
Miriam Lopian, MD
Mayanei Hayeshua Medical Center
Bnei Brak, HaMerkaz, Israel
Lior Kashani Ligumsky, MD, MSCR
Mayanei Hayeshua Medical Center
Tel-Aviv, Israel, Israel
Hagai Gershi, MD
Mayanei Hayeshua
Bnei Brak, HaMerkaz, Israel
Hadar Rosen, MD
Fetal Medicine specialist
Sheba Medical Center, Tel Hashomer
Toronto, Ontario, Canada
Olena Minich, MD
Mayanei Hayeshua
Bnei Brak, HaMerkaz, Israel
Maria Shvaikovsky, MD
Mayanei Hayeshua
Bnei Brak, HaMerkaz, Israel
Ariel Many, MD,MHA
Lis Maternity Hospital, Department of Obstetrics and Gynecology, Sourasky Medical Center, Tel Aviv University
Tel Aviv, Israel, Israel
Ioana Olteanu, MD
Mayanei Hayeshua Medical Center
Bnei Brak, HaMerkaz, Israel
Asaf Bilgory, MD
Hillel Yaffe Medical Center
Tel Aviv, Israel, Israel