Trial of labor after cesarean in women in their second delivery - labor characteristics and postpartum factors which influence a patient's choice.

ABSTRACT

INTRODUCTION: We aimed to assess trial of labor rates in patients in their second pregnancy following a cesarean delivery (CD), and asses the correlation to delivery and postpartum characteristics of their primary delivery. MATERIALS AND METHODS: This was a retrospective cohort of deliveries at our institution between 2009 and 2016. Files of patients with one past CD and a subsequent second delivery were reviewed. Included were patients with a favorable past indication for CD - malpresentation, nonreassuring fetal heart rate, multiple gestation, or placenta previa/abruption. Cases in which a TOLAC was undertaken were compared to those who did not undergo a TOLAC regarding maternal, obstetric, and neonatal outcomes. RESULTS: Five hundred and thirty-six deliveries matched the inclusion criteria, in which 269 patients attempted a TOLAC (TOLAC group) and 267 patients did not (no TOLAC group). Patient demographics at the time of primary CD were similar, but the rate of preterm deliveries was higher among the no TOLAC group. In their second delivery, patients who attempted a TOLAC were younger, had a lower body mass index, had a lower rate of assisted reproduction, and has less pregnancy-related complications (diabetes, hypertensive disorders). CONCLUSIONS: In patients with a first CD, a history of preterm delivery negatively correlated with a TOLAC, while patient age, body mass index and gestational comorbidities negatively affected TOLAC rates in subsequent delivery.