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Operative Obstetrics

Poster Session 1

(302) Maternal and Neonatal Outcomes of Trial of Labor After Cesarean in Parturients with Oligohydramnios

Tuesday, February 13, 2024

10:30 AM – 12:00 PM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Primary Author(s)

Ari Weiss, MD, MPH (he/him/his)

Shaare Zedek Medical Center, Hebrew University of Jerusalem
Jerusalem, Yerushalayim, Israel

Coauthor(s)

Tzuria Peled, MD (she/her/hers)

Dr, OBGYN, SZMC
Shaare Zedek Medical Center, Hebrew University of Jerusalem
Jerusalem, Yerushalayim, Israel
Yl

Yael T. lerner, MD

Israel
Givot Bar, HaDarom, Israel
Zvi Ehrlich, MD

Shaare Zedek Medical Center, Hebrew University of Jerusalem
Jerusalem, Yerushalayim, Israel
EA

Eran Ashwal‬‏, MD

Clinical Fellow
McMaster University
North York, Tel Aviv, Canada
HY

Hen Y. Sela, MD

Director maternity department D
Shaare Zedek Medical Center, affiliated with the Hebrew University Hadassah School of Medicine
Jerusalem, Israel, Israel
SG

Sorina Granovsky Grisaru, MD,PhD

head of Obstetrics & Gynecology, Shaare Zedek Medical Center, Jerusalem, Israel
Shaare Zedek Medical Center, Hebrew University of Jerusalem
Jerusalem, Yerushalayim, Israel

Presenting Author(s)

Misgav Rottenstreich, MBA, MD (he/him/his)

Clinical Fellow
McMaster University
Hamilton, ON, Canada

Objective: Oligohydramnios is considered a determinant of adverse perinatal outcomes. However, information on trial of labor after cesarean (TOLAC) for parturients with oligohydramnios is limited. This study aims to evaluate the maternal and neonatal outcomes of parturients with oligohydramnios attempting TOLAC versus those who underwent planned repeat cesarean delivery (PRCD).

Study Design: We conducted a retrospective cohort study of women with a term singleton pregnancy and a live fetus following a single low-segment transverse cesarean delivery (CD) and a diagnosis of oligohydramnios (maximal vertical pocket < 2 cm and/or Amniotic Fluid Index < 5 cm) within 14 days from birth between 2017 and 2021. Maternal and neonatal outcomes were compared between parturients attempting TOLAC and those opting for PRCD. Univariate analysis was conducted, followed by a multivariate analysis.

Results: A total of 409 eligible births were included, of which 321 (78.4%) attempted TOLAC. The successful vaginal delivery rate for women who attempted TOLAC was 85%. There were no cases of hysterectomy in either group. Uterine rupture and dehiscence of uterine scar rates did not significantly differ between those who had TOLAC vs. PRCD (0.9% vs. 0%, p=0.36 vs. 0.3% vs. 1.3%, p=0.06, respectively). However, the rate of hypoglycemia (2.5% vs. 6.8%, p=0.049) and composite adverse neonatal outcome was higher among women with PRCD (11.5% vs. 21.6%, p=0.01). Nevertheless, after controlling for potential confounders, including hypertensive disorders of pregnancy, diabetes, and SGA, no independent association between composite adverse neonatal outcome and PRCD was demonstrated (adjusted odds ratio 0.50, 95% CI 0.17-1.41, p=0.19).

Conclusion: TOLAC for parturients with oligohydramnios appears to be a reasonable alternative and is associated with favorable outcomes. Further large and prospective research in this area may lead to improved management strategies and better maternal and neonatal outcomes.