Operative Obstetrics
Poster Session 3
Or Lee Rak, MD (she/her/hers)
Helen Schneider Hospital for Women, Rabin Medical Center
Ramat Hasharon, HaMerkaz, Israel
Hadar Amdursky, MD
Rabin Medical Center
Petach-Tikva, HaMerkaz, Israel
Eran Hadar, Prof.
Rabin Medical Center
Petach-Tikva, HaMerkaz, Israel
Alexandra Berezowsky, MD
Sunnybrook Health Sciences Centre
Toronto, ON, Canada
Oxytocin is commonly used to enhance labor progression. Its application in Trial of Labor after Cesarean Section (TOLAC) requires special considerations, due to the risk of uterine rupture. Currently, limited data exists on the influence of oxytocin administration timing and duration on adverse outcomes during TOLAC. Our study aims to explore the correlation between the timing of oxytocin initiation, the duration of oxytocin administration, and the rates of uterine rupture and successful vaginal deliveries during TOLAC.
Study Design:
In this retrospective cohort study conducted from 2012 to 2020 at a single tertiary medical center, we included women with a prior single cesarean delivery attempting their first TOLAC and with no history of vaginal deliveries. Exclusions were made for women with multiple gestations or those who underwent cervical ripening. Outcome evaluation was performed using Receiver Operating Characteristic (ROC) curves.
Results:
A total of 385 women met the inclusion criteria. The mean age was 31.8 (±4.3) and Median gestational age at delivery was 40+3 weeks (37+0 - 41+6). Of women, 311 (80.78%) achieved successful vaginal delivery, while nine (2.34%) experienced uterine rupture. ROC analysis did not reveal significant associations between the timing of oxytocin administration and the primary outcomes: successful vaginal delivery (AUC= 0.56, p= 0.244) [Fig. 1A] and uterine rupture (AUC= 0.49, p= 0.902) [Fig. 1B]. However, the duration of oxytocin administration demonstrated a noteworthy correlation with successful vaginal delivery (AUC= 0.62, p= 0.008) [Fig. 1C], but not with uterine rupture (AUC= 0.54, p= 0.354) [Fig. 1D].
Conclusion:
Early initiating of oxytocin did not contribute to a higher rate of vaginal delivery during TOLAC. However, extended use of oxytocin was associated with improved success rates. Importantly, commencing oxytocin early and using it for an extended period did not elevate the risk of uterine rupture. Further extensive studies are required to comprehend the potential risks and benefits of early or prolonged oxytocin administration during TOLAC.