Who elects a trial of labor after cesarean delivery?

  • Groves P & al.
  • J Obstet Gynaecol Can
  • 27 Apr 2018

  • curated by Elisabeth Aron, MD, MPH, FACOG
  • Clinical Essentials
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Takeaway

  • Patient characteristics may affect willingness to undergo trial of labor after cesarean (TOLAC).

Why this matters

  • Efforts to decrease the cesarean delivery (CD) rates have included counseling for TOLAC.
  • Providers may discourage some women from pursuing TOLAC.

Key results

  • The overall TOLAC rate was low (10.1%).
  • There was 66.7% successful vaginal births after CD rate for women pursing TOLAC.
  • Factors tied to attempting TOLAC: lower BMI (P<.001 higher gestational age at delivery previous vaginal prior indication for cd was breech>
  • Factors associated with elective repeat CD: prior indication of failure to progress (P<.001 prior induction of labor attended classes>

Study design

  • Retrospective case-control study of women using a computerized database of women delivering in St. John's, Newfoundland and Labrador between 2001 and 2014.
  • Women who were potential candidates for TOLAC (n=1579) were identified.
  • Women desiring elective repeat CD (n=1419) compared with TOLAC (n=160).
  • Primary objective was to identify potential differences in demographic and clinical characteristics between women choosing elective repeat CD compared with those choosing TOLAC.
  • Funding: None disclosed.

Limitations

  • Data on how women were counseled not available.
  • Single institution with homogeneous population; therefore, results may not be generalizable.

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