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Trial of labor following cesarean in preterm deliveries: success rates and maternal and neonatal outcomes: a multicenter retrospective study

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the rates of vaginal birth after cesarean (VBAC) among parturients attempting preterm trial of labor following a cesarean delivery (TOLAC) vs. term TOLAC.

Methods

A multicenter historic cohort study was conducted at two university-affiliated centers between August 2005 and March 2021. Parturients in their second delivery, attempting TOLAC after a single low segment transverse cesarean delivery were included. We retrospectively examined computerized medical records of all preterm (< 37 weeks) and term (37–42 weeks) births. Multifetal gestations and postterm deliveries (≥ 42 weeks) were excluded. A univariate analysis was conducted, followed by a multivariate analysis.

Results

4865 second deliveries following previous cesarean were identified: 212 (4.4%) preterm and 4653 (95.6%) term. Hypertensive disorders, diabetes and fertility treatments were significantly more prevalent in the preterm group. VBAC rate was significantly lower in preterm group (57.5 vs 79.7%., p < 0.01), including both spontaneous and vaginal-assisted deliveries. In multivariate analysis, preterm TOLAC was independently associated with TOLAC failure [adjusted odds ratio 2.24, [95% confidence interval 1.62–3.09]. Overall, maternal outcomes were favorable. Rates of uterine rupture, re-laparotomy and postpartum hemorrhage were comparable between groups. Neonatal outcomes were less favorable among the preterm group; however, preterm vs. term TOLAC was not associated with low 5 min Apgar score (aOR 1.76, 95% CI 0.92–3.40).

Conclusion

In our study, VBAC rates were lower in preterm compared to term deliveries. Maternal outcomes were comparable. Neonatal outcomes were less favorable in the preterm group, more likely due to prematurity than delivery mode.

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Funding

The authors received no personal funding for this study.

Author information

Author notes

  1. Reut Rotem and Ayala Hirsch contributed equally to this work.

  2. Rachel Michaelson-Cohen and Misgav Rottenstreich contributed equally to this work.

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University Faculty of Medicine, POB 3235, 91031, Jerusalem, Israel

    Reut Rotem, Ayala Hirsch, Moshe Barg, Pnina Mor, Rachel Michaelson-Cohen & Misgav Rottenstreich

  2. Department of Nursing, Jerusalem College of Technology, Jerusalem, Israel

    Misgav Rottenstreich

  3. Medical Genetics Institute, Shaare Zedek Medical Center, Hebrew University Faculty of Medicine, Jerusalem, Israel

    Pnina Mor & Rachel Michaelson-Cohen

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  1. Reut Rotem
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Contributions

RR: planned, carried out, analyzed, and wrote the article. AH: carried out the study data collection. MB: helped with planning and conception of the study. RMC: assisted in carrying out, analyzing, writing, and editing the article. SGG: helped with conception of study and its editing. MR: participated in writing the article. PM: edited the article.

Corresponding author

Correspondence to Rachel Michaelson-Cohen.

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Conflict of interest

All authors declare no conflict of interests and received no personal funding.

Ethical approval

The study protocol was reviewed and approved by the local ethics committee Institutional Review Board (IRB) of the Shaare Zedek Medical Center, in accordance with the principles of the Declaration of Helsinki (IRB: 0411-21-SZMC), date of approval: June 1, 2021.

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Rotem, R., Hirsch, A., Barg, M. et al. Trial of labor following cesarean in preterm deliveries: success rates and maternal and neonatal outcomes: a multicenter retrospective study. Arch Gynecol Obstet 308, 863–870 (2023). https://doi.org/10.1007/s00404-022-06746-3

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  • DOI: https://doi.org/10.1007/s00404-022-06746-3

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