Outcome with trial of labor after cesarean (TOLAC) or elective repeat cesarean delivery on maternal request (ERCD-MR): a comparative study

Abstract

Aim: To compare outcomes with trial of labor after cesarean (TOLAC) or elective repeat cesarean delivery on maternal request (ERCD-MR). Methods: A prospective study was conducted in the Department of obstetrics and gynaecology, Narayan Medical College and Hospital, Jamuhar, Sasaram, Bihar, India from march 2018 to July 2019. Total 600 patients were included in this study. Results: TOLAC was associated with an increased risk of neonatal depression [odds ratio (OR) 3.2, 95% confidence interval (CI) 1.2–9.3] and neonatal intensive care unit admission (adjusted OR 1.7, 95% CI 1.4–2.6). Within the TOLAC group 75% delivered vaginally. In the TOLAC group 2% (n = 8) of the women had a complete uterine rupture. None of these infants had sequelae after 12 months. Significant risk factors for emergency cesarean were no prior vaginal delivery (adjusted OR 1.6, 95% CI 1.1–3.2), index emergency cesarean during labor (adjusted OR 3.2, 95% CI 2.4–4.0), maternal age ≥35 years (adjusted OR 2.1, 95% CI 1.4–2.1), pre-pregnancy body mass index ≥30 (adjusted OR 2.3, 95% CI 1.1–3.5), and birthweight 4000–4499 g (adjusted OR 1.4, 95% CI 1.2–2.3). Uterine rupture was associated with the use of epidural analgesia (OR 2.2, 95% CI 1.1–4.9) and no prior vaginal delivery (p = 0.02).  Conclusion: TOLAC is an acceptable individualized option for women without major risk factors.

Keywords: Surgery, Study, women.