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

• Published in: Journal of Midwifery & Reproductive Health
• Main Authors: Leila Pourali, Atiyeh Vatanchi, Sedigheh Ayati, Masoumeh Mirteimouri, Hasan Mehrad-Majd, Farzaneh Delkhah
• Format: Article
• Language: English
• Published: Mashhad University of Medical Sciences 2024-07-01
• Subjects: vaginal birth after cesarean; trial of labor; cesarean section; vaginal delivery; fetal distress
• Online Access: https://jmrh.mums.ac.ir/article_23442_793dbbbe05bc8f6c40301ceae0e85658.pdf

Background & aim: Trial of labor after cesarean (TOLAC) to achieve vaginal delivery is considered acceptable in women with one previous cesarean. This study was performed to compare the success rate and maternal and neonatal outcomes of TOLAC after one and two previous cesarean sections.Methods: This cross-sectional study was conducted in September 2018 and March2020 by convenience sampling on 339 pregnant women with a history of one or two previous cesarean sections in Mashhad. TOLAC was performed for all eligible participants, if cesarean section performed due to any reason, it was considered a failed TOLAC. Maternal and neonatal outcomes by a check list were recorded during TOLAC and one week later. Data were analyzed by SPSS (version 24). Results: TOLAC was successful in 301 cases (94.1%), but 19 (5.9%) underwent cesarean section. Maternal age, parity, and frequency of comorbidities were significantly higher in those with two previous cesarean sections compared to those with one previous cesarean section (P<0.05). Induction of labor was significantly higher in cesarean section compared to the TOLAC group (P=0.003). However, none of the pregnancy 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 enough success rate to justify recommending it to the selected women with one or two previous cesarean section.