The Success Rate and Outcomes in Trial of Labor after One or Two Cesarean Sections: A Cross-Sectional Study

Document Type : Original Research Article

Authors

1 Associate Professor, Fellowship of Pelvic Floor Disorders, Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Assistant Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

3 Gynecologist, Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

4 Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

5 Associate Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

6 Clinical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Background & aim: Trial of labor after cesarean (TOLAC) to achieve vaginal delivery (VBAC) is considered acceptable in women with one previous cesarean section. This study was performed to compare maternal and neonatal outcomes of TOLAC after one or two previous cesarean sections.
Methods: This cross-sectional study was conducted in 2018-2020 on 339 pregnant women with history of one or two previous cesarean sections referred to the maternity wards of Mashhad, Iran. TOLAC was performed for all eligible participants, if cesarean section performed due to any reason, it was considered as a failed TOLAC and the cause of cesarean section was recorded. Maternal and neonatal outcomes were recorded during VBAC and one week later. Data were analyzed by SPSS (version 24) using Student t-test, Mann-Whitney U test and Chi-square.
Results: Maternal age, parity and frequency of comorbidities were significantly higher in those with two previous cesarean sections compared to those with one (P<0.05). TOLAC was successful in 301 cases (94.1%), but 19 (5.9%) underwent cesarean section. Induction of labor was significantly higher in cesarean section compared to VBAC group. However, any of the obstetric outcomes including induction of labor, postpartum hemorrhage, blood transfusion, birth weight, first minute Apgar score, fifth minute Apgar score, NICU admission and breastfeeding in the first 48 hours were not significantly different between those with one or two cesarean sections (P>0.05).
Conclusion: Considering standard precautions in patient selection, TOLAC has a high success rate to justify recommending it to the selected women with one or two previous cesarean sections.

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