Trial of labor after 2 previous cesareans: a multicenter study

Yael Gold Zamir, Tzuria Peled, Hila Hochler, Hen Y. Sela, Ari Weiss, Michal Lipschuetz, Joshua Isaac Rosenbloom, Sorina Grisaru-Granovsky, Misgav Rottenstreich

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Trial of labor after cesarean after 2 cesarean deliveries is linked to a lower success rate of vaginal delivery and higher rates of adverse obstetrical outcomes than trial of labor after cesarean after 1 previous cesarean delivery. OBJECTIVE: This study aimed to investigate the factors associated with failed trial of labor after cesarean among women with 2 previous cesarean deliveries. STUDY DESIGN: This was a multicenter retrospective cohort study, which included all women with singleton pregnancies attempting trial of labor after cesarean after 2 previous cesarean deliveries between 2003 and 2021. This study compared labor, maternal, and neonatal characteristics between women with failed trial of labor after cesarean and those with successful trial of labor after cesarean. Univariate analysis was initially performed, followed by multivariable analysis (adjusted odds ratios with 95% confidence intervals). RESULTS: The study included a total of 1181 women attempting trial of labor after cesarean after 2 previous cesarean deliveries. Among these cases, vaginal birth after cesarean was achieved in 973 women (82.4%). Women with failed trial of labor after cesarean had higher rates of maternal and neonatal morbidities. Several factors were found to be associated with failed trial of labor after cesarean, including longer interpregnancy and interdelivery intervals, lower gravidity and parity, lower rates of previous successful vaginal delivery, smoking, earlier gestational age at delivery (38.3±2.1 vs 39.5±1.3 weeks), late preterm delivery (34–37 weeks of gestation), lower cervical dilation on admission, no use of epidural, and smaller neonatal birthweight. Our multivariable model revealed that late preterm delivery (adjusted odds ratio, 3.79; 95% confidence interval, 1.37–10.47) and cervical dilation on admission for labor <3 cm (adjusted odds ratio, 2.58; 95% confidence interval, 1.47–4.54) were associated with higher odds of failed trial of labor after cesarean. CONCLUSION: In the investigated population of women with 2 previous cesarean deliveries undergoing trial of labor after cesarean, admission at the late preterm period with a cervical dilation of <3 cm, which reflects the latent phase, may elevate the risk of failed trial of labor after cesarean and a repeated intrapartum cesarean delivery.

Original languageEnglish
Article number101209
JournalAmerican Journal of Obstetrics and Gynecology MFM
Volume6
Issue number4
DOIs
StatePublished - Apr 2024
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2023 Elsevier Inc.

Keywords

  • 2 previous cesarean deliveries
  • cesarean delivery
  • maternal morbidity
  • multicenter study
  • neonatal morbidity
  • obstetrical outcomes
  • preterm delivery
  • trial of labor after cesarean
  • trial of labor after cesarean success
  • vaginal birth after cesarean

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