(656) Rising Trends in Perinatal Morbidity Following Trial of Labor after Cesarean Delivery: Population-Based Study

Friday, February 10, 2023

10:30 AM – 12:00 PM

Objective: We aimed to investigate trends in major maternal and neonatal morbidities following the trial of labor after Cesarean delivery (TOLAC).

Study Design: In this study, we evaluated the ten-year trends in maternal and neonatal morbidity following TOLAC from the vital statistics natality birth data provided by National Center for Health Statistics, Centers for Disease Control and Prevention (CDC) from January 2011 to December 2020. Trends were evaluated in the following four populations: successful Vaginal birth after Cesarean delivery (VBAC), failed TOLAC [women who underwent CD after a failed trial of labor], elective repeat CD [women with a previous history of CD delivered via CD without any attempt for vaginal birth], and total United States birth population. The Mann-Kendall test was used to assess the trend.

Results: From 2011-2020, 675,743 (70.89%) had successful VBAC, 953,115 women underwent TOLAC, and 4,596,029 women delivered via elective repeat CD. Uterine rupture was higher in failed TOLAC population with a significant inclining trend (p-value 0.004). The unplanned hysterectomy, maternal transfusion, and intensive care unit (ICU) admission following the delivery were higher in mothers who underwent elective repeat CD and failed TOLAC, with an inclining trend in recent years. Regarding neonatal morbidity, the neonatal ICU admission more frequently occurred following the failed TOLAC and elective repeat CD with a significantly increasing trend in all four populations (p-value < 0.001 for all populations).

Conclusion: Successful VBAC has the best outcome in terms of perinatal morbidity compared to repeat elective CD and failed TOLAC. A significant rising trend has been reported following TOLAC in recent years for the major perinatal morbidities in comparison to the total United States population. Our results present vital counseling points for patients considering TOLAC; particularly those who have lower chances for successful VBAC. It also highlights the need to reassess management strategies of pregnancies undergoing TOLAC.

Primary & Presenting Author(s)

Ali Javinani, MD (he/him/his)
Post-doctoral Research Fellow
Maternal Fetal Care Center, Boston Children's Hospital, Harvard Medical School
Boston, Massachusetts, United States

Coauthor(s)

MH
Mohammad-Hossein Heydari, N/A
Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences
Tehran, Tehran, Iran
Asma Khalil, MD, MSc (she/her/hers)
Professor of Maternal Fetal Medicine
St George's Hospital, University of London
London, England, United Kingdom
Mark B. Landon, MD
Richard L. Meiling Professor and Chair, Obstetrics and Gynecology
The Ohio State University
Columbus, Ohio, United States
Vincenzo Berghella, MD
Professor, Director
Sidney Kimmel Medical College at Thomas Jefferson University
Philadelphia, Pennsylvania, United States
Rohan D'Souza, FRCOG, MD, PhD
Maternal-Fetal Medicine Physician, Associate Professor of Obstetrics & Gynaecology
Department of Obstetrics and Gynaecology, Department of Health Research Methods, Evidence and Impact, McMaster University
Hamilton, Ontario, Canada
Hiba J. Mustafa, MD
Assistant Professor of Fetal Surgery and Maternal-Fetal Medicine
Indiana University Riley Children's Hospital Fetal Center
Carmel, Indiana, United States