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Gitas G, Alkatout I, Ertan KA, Rody A, Proppe L, Kocaer M, Laganà AS, Allahqoli L, Mikos T, Sommer S, Baum S. Risk factor analysis in women who underwent trial of labor after cesarean section: a multicenter study in xxxxxx. J Turk Ger Gynecol Assoc 2022; 23:137-144. [PMID: 35781586 PMCID: PMC9450926 DOI: 10.4274/jtgga.galenos.2022.2022-1-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: Rising caesarean delivery (CD) rates throughout the world are accompanied with high rates of severe maternal complications. The aim of the present study was to analyze the outcome of trial of labor after caesarean section (TOLAC) in a Western population and identify factors associated with the success of vaginal birth after caesarean section (VBAC). Material and Methods: A retrospective study was performed at two large obstetric departments in Germany from 2008 to 2018. Women with singleton pregnancies, a history of only one previous CD with a low transverse incision, a viable fetus in cephalic presentation, and gestational age >32 weeks were included in the study. The characteristics and outcome of successful VBAC and failed TOLAC were compared. A subgroup analysis addressed gestational age, interpregnancy interval, fetal macrosomia, body mass index, and maternal age. Results: Of 1,546 patients, 62.3% achieved VBAC while 37.7% had a secondary CD. Independent factors associated with the success of TOLAC were a history of vaginal birth in previous pregnancies (p<0.001) and the use of oxytocin (p<0.001), whereas preterm birth between gestational week 32 and 37 signified a higher risk of failed TOLAC (p=0.04). The success of VBAC did not differ significantly for patients older than 40 years of age, those with a shorter interpregnancy interval than 12 months, and fetal macrosomia with birth weight exceeding 4000 grams. Maternal and neonatal outcomes were poorer in women with failed TOLAC. Conclusion: Nearly two thirds of women with a history of CD achieve VBAC in Germany. Previous vaginal birth and the augmentation of labor with oxytocin are positively associated with the achievement of VBAC and no major perinatal complications. The decision to have a TOLAC should be encouraged in the majority of patients. Further studies are needed to evaluate the feasibility of TOLAC in preterm delivery.
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Affiliation(s)
- George Gitas
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Luebeck, Germany, Berlin, Berlin, Germany
| | - Ibrahim Alkatout
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Luebeck, Germany, Berlin, Berlin, Germany
| | - Kubilay A Ertan
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Luebeck, Germany, Berlin, Berlin, Germany
| | - Achim Rody
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Luebeck, Germany, Berlin, Berlin, Germany
| | - Louisa Proppe
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Luebeck, Germany, Berlin, Berlin, Germany
| | - Mustafa Kocaer
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Luebeck, Germany, Berlin, Berlin, Germany
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Luebeck, Germany, Berlin, Berlin, Germany
| | - Leila Allahqoli
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Luebeck, Germany, Berlin, Berlin, Germany
| | - Themistoklis Mikos
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Luebeck, Germany, Berlin, Berlin, Germany
| | - Soteris Sommer
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Luebeck, Germany, Berlin, Berlin, Germany
| | - Sascha Baum
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Luebeck, Germany, Berlin, Berlin, Germany
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Bălălău OD, Bacalbașa N, Olaru OG, Pleș L, Stănescu DA. Vaginal birth after cesarean section – literature review and modern guidelines. JOURNAL OF CLINICAL AND INVESTIGATIVE SURGERY 2020. [DOI: 10.25083/2559.5555/5.1/13.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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