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Maternal and Neonatal Outcomes Following Trial of Labor After Two Previous Cesareans: a Retrospective Cohort Study

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Abstract

The objective of this study is to evaluate the maternal and neonatal outcomes of parturients attempting trial of labor (TOL) after two previous CD versus those who had an elective third repeat CD. A retrospective computerized database cohort study was conducted at a single tertiary center between 2005 and 2019. Various maternal and neonatal outcomes were compared between parturients attempting TOL after two CD versus parturients opting for elective third repeat CD. TOL after two CD was allowed only for those who met all the criteria of our departments’ protocol. Parturients with identified contraindication to vaginal delivery were excluded from the analysis. A univariate analysis was conducted and was followed by a multivariate analysis. A total of 2719 eligible births following two CD were identified, of which 485 (17.8%) had attempted TOL. Successful vaginal delivery rate following two CDs was 86.2%. Uterine rupture rates were higher among those attempting TOL (0.6% vs 0.1% p = 0.04). However, rates of hysterectomy, re-laparotomy, blood product infusion, and intensive care unit admission did not differ significantly between the groups. Neonatal outcomes following elective repeat CD were less favorable (specifically, neonatal intensive care unit admission and composite adverse neonatal outcome). Nonetheless, when controlling for potential confounders, an independent association between composite adverse neonatal outcome and an elective repeat CD was not demonstrated. In a subgroup analysis, diabetes mellitus and hypertensive disorders of pregnancy were found independently associated with failed TOLAC. When following a strict protocol, TOL after two CD is a reasonable alternative and associated with favorable outcomes.

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Acknowledgments

We thank Pnina Mor, PhD for the critical appraisal of the manuscript and English editing.

Author information

Author notes

  1. Ayala Hirsch contributed equally to this work.

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel

    Reut Rotem, Ayala Hirsch, Hen Y. Sela, Arnon Samueloff, Sorina Grisaru-Granovsky & Misgav Rottenstreich

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

    Misgav Rottenstreich

Authors
  1. Reut Rotem
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  2. Ayala Hirsch
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  3. Hen Y. Sela
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Contributions

R Rotem: Protocol development, data collection and management, data analysis, and manuscript writing/editing.

A Hirsch: Protocol development, data collection and management, data analysis, and manuscript writing/editing.

HY Sela: Data collection and management, and manuscript writing/editing.

A Samueloff: Data collection and management, and manuscript writing/editing.

S Grisaru-Granovsky: Protocol development, and manuscript writing/editing.

M Rottenstriech: Protocol development, data collection and management, data analysis, abd manuscript writing/editing.

Corresponding author

Correspondence to Reut Rotem.

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The study was approved by the local institutional ethics committee in accordance with the principles of the Declaration of Helsinki (IRB: 001-20-SZMC).

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The authors declare that they have no conflict of interest.

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Rotem, R., Hirsch, A., Sela, H.Y. et al. Maternal and Neonatal Outcomes Following Trial of Labor After Two Previous Cesareans: a Retrospective Cohort Study. Reprod. Sci. 28, 1092–1100 (2021). https://doi.org/10.1007/s43032-020-00378-1

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  • DOI: https://doi.org/10.1007/s43032-020-00378-1

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