Failed TOLAC in women 40 and over: risk factors identified

Takeaway

• The cause of cesarean delivery (CD) affects the success of future trials of labor after cesarean (TOLACs) in women age ≥40 years.

Why this matters

• This information could be useful for TOLAC counseling.
• Advanced maternal age is associated with increased incidence of maternal and neonatal morbidity.

Key results

• 62.3% had a successful TOLAC; 37.7% had a failed TOLAC.
• Dysfunctional labor at first delivery (aOR, 13.40; P=.03) and higher birth weight differences between deliveries (aOR, 1.18; P=.02) were predictors of TOLAC.

Study design

• Retrospective case-control study of women who delivered at 1 hospital in Israel between 2006 and 2017.
• Women age ≥40 years with a second delivery after a history of a primary low-transverse CD were included (n=7625).
• Women with successful TOLAC were compared with women with failed TOLAC.
• Funding: None disclosed.

Limitations

• Retrospective design.
• Small cohort in study.