Skip to main content
SpringerLink
Log in

Prediction of successful trial of labor after cesarean among grand-multiparous women

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

Abstract

Purpose

To determine the factors associated with successful trial of labor after cesarean (TOLAC) among grand-multiparous (GMP) women.

Methods

A retrospective cohort study was conducted, including all GMP women (≥ 5 deliveries) undergoing TOLAC during 3/2011 and 6/2020, delivering a singleton cephalic newborn. Factors associated with successful vaginal delivery were examined by multivariable analysis.

Results

Overall, 381/413 (92.2%) GMP succeeded TOLAC. Maternal characteristics did not differ between TOLAC success and TOLAC failure groups. Previous cesarean delivery characteristics did not differ between study groups. The median number of previous vaginal births after cesarean was 2 [interquartile range 1–4]. Gestational age at TOLAC was lower in the success group (mean 371/7 ± 36/7 vs. 385/7 ± 31/7 weeks, p = 0.028). A lower rate of modified Bishop score < 4 was associated with TOLAC success [149 (39.1%) vs. 22 (69%), odds ratio (OR) 95% confidence interval (CI) 0.29 (0.13–0.64), p = 0.001]. The rate of induction of labor was higher in the TOLAC failure group [120 (31.5%) vs. 17 (53%), OR 95% CI 0.40 (0.19–0.83), p = 0.013]. The rate of oxytocin administration was higher in the TOLAC failure group [94 (24.7%) vs. 15 (47%) OR (95% CI) 0.37 (0.17–0.77), p = 0.006]. The duration of rupture of membranes was negatively associated with TOLAC success. Neonatal and maternal adverse outcomes did not differ between study groups. In multivariable logistic regression analysis, only the duration of rupture of membranes and modified Bishop score < 4 were independently associated with TOLAC success [adjusted OR (95% CI) 0.98 (0.96–0.99), p = 0.027 and 0.40 (0.16–0.97), p = 0.044].

Conclusion

TOLAC among GMP has a very-high success rate. Shortening the duration of ruptured membranes is a modifiable factor that may be associated with increased TOLAC success rates.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

CD:

Cesarean delivery

GMP:

Grand multiparous

TOLAC:

Trial of labor after cesarean

VBAC:

Vaginal birth after cesarean

References

  1. Bai J, Wong FW, Bauman A, Mohsin M (2002) Parity and pregnancy outcomes. Am J Obstet Gynecol 186:274–278

    Article  Google Scholar 

  2. Chandra A, Copen CE, Stephen EH (2013) Infertility and impaired fecundity in the United States, 1982–2010: data from the National Survey of Family Growth. Natl Health Stat Rep. p 1–18, 1 p following 19

  3. Paliwal V, Dikhit S, Singh S (2009) Safety of induction of labor with vaginal prostaglandins (e2) in grandmultipara. Oman Med J 24:184–187

    PubMed  PubMed Central  Google Scholar 

  4. Kugler E, Shoham-Vardi I, Burstien E, Mazor M, Hershkovitz R (2008) The safety of a trial of labor after cesarean section in a grandmultiparous population. Arch Gynecol Obstet 277:339–344

    Article  Google Scholar 

  5. Yamani Zamzami TY (2004) Vaginal birth after cesarean section in grand multiparous women. Arch Gynecol Obstet 270:21–24

    Article  Google Scholar 

  6. Ram M, Hiersch L, Ashwal E, Yogev Y, Aviram A (2021) Trial of labor after previous single cesarean delivery in grand-multiparous women: a retrospective cohort study. Arch Gynecol Obstet. https://doi.org/10.1007/s00404-020-05946-z

    Article  PubMed  Google Scholar 

  7. Hochler H, Yaffe H, Schwed P, Mankuta D (2014) Safety of trial of labor after cesarean delivery in grandmultiparous women. Obstet Gynecol 123:304–308

    Article  Google Scholar 

  8. Grobman WA, Lai Y, Landon MB et al (2009) Does information available at admission for delivery improve prediction of vaginal birth after cesarean? Am J Perinatol 26:693–701

    Article  Google Scholar 

  9. ACOG Practice Bulletin No. 202 (2019) Gestational hypertension and preeclampsia. Obstet Gynecol 133:e1–e25

    Google Scholar 

  10. AD Association (2011) Standards of medical care in diabetes—2011. Diabetes Care 34(Suppl 1):S11-61

    Article  Google Scholar 

  11. Carpenter MW, Coustan DR (1982) Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol 144:768–773

    Article  CAS  Google Scholar 

  12. Levine LD, Downes KL, Parry S, Elovitz MA, Sammel MD, Srinivas SK (2018) A validated calculator to estimate risk of cesarean after an induction of labor with an unfavorable cervix. Am J Obstet Gynecol 218:254.e1–54.e7

    Article  Google Scholar 

  13. Osmundson S, Ou-Yang RJ, Grobman WA (2011) Elective induction compared with expectant management in nulliparous women with an unfavorable cervix. Obstet Gynecol 117:583–587

    Article  Google Scholar 

  14. Laughon SK, Zhang J, Troendle J, Sun L, Reddy UM (2011) Using a simplified Bishop score to predict vaginal delivery. Obstet Gynecol 117:805–811

    Article  Google Scholar 

  15. Vrouenraets FP, Roumen FJ, Dehing CJ, van den Akker ES, Aarts MJ, Scheve EJ (2005) Bishop score and risk of cesarean delivery after induction of labor in nulliparous women. Obstet Gynecol 105:690–697

    Article  Google Scholar 

  16. Meyer R, Hendin N, Zamir M et al (2020) Implementation of machine learning models for the prediction of vaginal birth after cesarean delivery. J Matern Fetal Neonatal Med. https://doi.org/10.1080/14767058.2020.1837769

    Article  PubMed  Google Scholar 

  17. Metz TD, Stoddard GJ, Henry E, Jackson M, Holmgren C, Esplin S (2013) Simple, validated vaginal birth after cesarean delivery prediction model for use at the time of admission. Obstet Gynecol 122:571–578

    Article  Google Scholar 

  18. Navve D, Orenstein N, Ribak R, Daykan Y, Shechter-Maor G, Biron-Shental T (2017) Is the Bishop-score significant in predicting the success of labor induction in multiparous women? J Perinatol 37:480–483

    Article  CAS  Google Scholar 

  19. Gurewitsch ED, Johnson E, Allen RH et al (2003) The descent curve of the grand multiparous woman. Am J Obstet Gynecol 189:1036–1041

    Article  Google Scholar 

  20. Graseck A, Tuuli M, Roehl K, Odibo A, Macones G, Cahill A (2014) Fetal descent in labor. Obstet Gynecol 123:521–526

    Article  Google Scholar 

  21. Hochler H, Wainstock T, Lipschuetz M et al (2020) Grandmultiparity, maternal age, and the risk for uterine rupture—a multicenter cohort study. Acta Obstet Gynecol Scand 99:267–273

    Article  Google Scholar 

  22. Landon MB, Leindecker S, Spong CY et al (2005) The MFMU cesarean registry: factors affecting the success of trial of labor after previous cesarean delivery. Am J Obstet Gynecol 193:1016–1023

    Article  Google Scholar 

  23. ACOG Practice Bulletin No. 205 (2019) Vaginal birth after cesarean delivery. Obstet Gynecol 133:e110–e127

    Article  Google Scholar 

  24. Zelop CM, Shipp TD, Repke JT, Cohen A, Lieberman E (2001) Outcomes of trial of labor following previous cesarean delivery among women with fetuses weighing >4000 g. Am J Obstet Gynecol 185:903–905

    Article  CAS  Google Scholar 

  25. Elkousy MA, Sammel M, Stevens E, Peipert JF, Macones G (2003) The effect of birth weight on vaginal birth after cesarean delivery success rates. Am J Obstet Gynecol 188:824–830

    Article  Google Scholar 

  26. Flamm BL, Goings JR (1989) Vaginal birth after cesarean section: is suspected fetal macrosomia a contraindication? Obstet Gynecol 74:694–697

    CAS  PubMed  Google Scholar 

  27. Grisaru-Granovsky S, Bas-Lando M, Drukker L et al (2018) Epidural analgesia at trial of labor after cesarean (TOLAC): a significant adjunct to successful vaginal birth after cesarean (VBAC). J Perinat Med 46:261–269

    Article  CAS  Google Scholar 

  28. Reif P, Brezinka C, Fischer T et al (2016) Labour and childbirth after previous caesarean section: recommendations of the Austrian society of obstetrics and gynaecology (OEGGG). Geburtshilfe Frauenheilkd 76:1279–1286

    Article  CAS  Google Scholar 

  29. Hueston WJ, McClaflin RR, Mansfield CJ, Rudy M (1994) Factors associated with the use of intrapartum epidural analgesia. Obstet Gynecol 84:579–582

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

None.

Funding

No external funding was used in the conduct of this study.

Author information

Authors and Affiliations

  1. Department of Gynecologic Oncology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, POB 12000, 91120, Jerusalem, Israel

    Gabriel Levin

  2. Faculty of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel

    Gabriel Levin

  3. Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel

    Abraham Tsur & Raanan Meyer

  4. Faculty of Medicine, Tel-Aviv-Hebrew University, Tel-Aviv, Israel

    Abraham Tsur, Lee Tenenbaum, Nizan Mor, Michal Zamir & Raanan Meyer

Authors
  1. Gabriel Levin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Abraham Tsur
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lee Tenenbaum
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nizan Mor
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michal Zamir
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Raanan Meyer
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the manuscript. GL, RM and AT reviewed the literature and wrote the paper. NM, LT and MZ performed and collected the data. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Gabriel Levin.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study protocol was approved by the Sheba Medical Center review board (7145-20-SMC, 30/09/2020).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Levin, G., Tsur, A., Tenenbaum, L. et al. Prediction of successful trial of labor after cesarean among grand-multiparous women. Arch Gynecol Obstet 306, 373–378 (2022). https://doi.org/10.1007/s00404-021-06311-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-021-06311-4

Keywords

Search

Navigation