Operative Obstetrics
Poster Session 1
Yael Zamir, MD
Mayanei Hayeshua Medical Center
Bnei Brak, HaMerkaz, Israel
Tzuria Peled, MD (she/her/hers)
Dr, OBGYN, SZMC
Shaare Zedek Medical Center, Hebrew University of Jerusalem
Jerusalem, Yerushalayim, Israel
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Hila Hochler, MD
Department of obstetrics and gynecology, Hadassah Mount-scopus, Jerusalem
Hadassah Medical Center
Jerusalem, Yerushalayim, Israel
Ari Weiss, MD, MPH (he/him/his)
Shaare Zedek Medical Center, Hebrew University of Jerusalem
Jerusalem, Yerushalayim, Israel
Michal Lipschuetz, PhD
Hadassah Medical Center
Jerusalem, Yerushalayim, Israel
Eran Ashwal, MD
Clinical Fellow
McMaster University
North York, Tel Aviv, Canada
Hen Y. Sela, MD
Director maternity department D
Shaare Zedek Medical Center, affiliated with the Hebrew University Hadassah School of Medicine
Jerusalem, Israel, Israel
Sorina Grisaru-Granovsky, MD, PhD
Shaare Zedek Medical Center, Hebrew University of Jerusalem
Jerusalem, Yerushalayim, Israel
Misgav Rottenstreich, MBA, MD (he/him/his)
Clinical Fellow
McMaster University
Hamilton, ON, Canada
Trial of labor after cesarean (TOLAC) after two cesarean deliveries (CDs) is linked to a lower success rate of vaginal delivery and higher rates of adverse obstetrical outcomes compared to TOLAC after one previous cesarean. We aimed to investigate the factors associated with failed TOLAC among women with two previous CDs.
Study Design:
We conducted a multicenter retrospective cohort study, which included all women with singleton pregnancies 34-42 weeks attempting TOLAC after two previous CDs between the years 2003 and 2021 from four large university affiliated medical center in Israel accounted for approximately 25% of all deliveries in the country. We compared labor, maternal, and neonatal characteristics between women with failed TOLAC and those with successful TOLAC. Univariate analysis was initially performed, followed by multivariable analysis (adjusted odds ratios [aORs]; [95% CI]).
Results:
The study included a total of 1181 women attempting TOLAC after two previous CDs. Among these cases, vaginal birth after cesarean was achieved in 973 (82.4%). Several factors were found to be associated with failed TOLAC, including longer inter-pregnancy and inter-delivery intervals, lower gravidity and parity, lower rates of previous successful vaginal delivery, smoking, earlier gestational age at delivery, preterm delivery (34- 37 gestational weeks), lower cervical dilation on admission, non-use of epidural, and smaller neonatal birthweight. Our multivariable model revealed that preterm delivery (aOR=3.79, 95% CI 1.37-10.47) and cervical dilation on admission of labor < 3 cm (aOR=2.58, 95% CI 1.47-4.54) were associated with higher odds of failed TOLAC.
Conclusion: In the investigated population of women with two previous CDs undergoing TOLAC, admission at active labor at term may elevate the chances of successful TOLAC and reduce the risk of repeated cesarean delivery.