Trial of labor after 2 previous cesareans: a multicenter study

Yael Gold Zamir; Tzuria Peled; Hila Hochler; Hen Y Sela; Ari Weiss; Michal Lipschuetz; Joshua Isaac Rosenbloom; Sorina Grisaru-Granovsky; Misgav Rottenstreich

doi:10.1016/j.ajogmf.2023.101209

Trial of labor after 2 previous cesareans: a multicenter study

Am J Obstet Gynecol MFM. 2023 Dec 1:101209. doi: 10.1016/j.ajogmf.2023.101209. Online ahead of print.

Authors

Yael Gold Zamir¹, Tzuria Peled², Hila Hochler³, Hen Y Sela², Ari Weiss², Michal Lipschuetz⁴, Joshua Isaac Rosenbloom³, Sorina Grisaru-Granovsky², Misgav Rottenstreich⁵

Affiliations

¹ Department of Obstetrics and Gynecology, Mayanei Hayeshua Medical Center, Bnei Brak, Israel (Dr Zamir); Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (Dr Zamir).
² Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel (Drs Peled, Sela, Weiss, Grisaru-Granovsky, and Rottenstreich).
³ Faculty of Medicine, Department of Obstetrics and Gynecology, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel.
⁴ Faculty of Medicine, Department of Obstetrics and Gynecology, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel; Faculty of Medicine, Henrietta Szold Hadassah-Hebrew University School of Nursing, Jerusalem, Israel (Dr Lipschuetz).
⁵ Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel (Drs Peled, Sela, Weiss, Grisaru-Granovsky, and Rottenstreich); Department of Nursing, Jerusalem College of Technology, Jerusalem, Israel. Electronic address: misgavr@Gmail.com.

PMID: 38536661
DOI: 10.1016/j.ajogmf.2023.101209

Abstract

Background: Trial of labor after cesarean after 2 cesarean deliveries is linked to a lower success rate of vaginal delivery and higher rates of adverse obstetrical outcomes than trial of labor after cesarean after 1 previous cesarean delivery.

Objective: This study aimed to investigate the factors associated with failed trial of labor after cesarean among women with 2 previous cesarean deliveries.

Study design: This was a multicenter retrospective cohort study, which included all women with singleton pregnancies attempting trial of labor after cesarean after 2 previous cesarean deliveries between 2003 and 2021. This study compared labor, maternal, and neonatal characteristics between women with failed trial of labor after cesarean and those with successful trial of labor after cesarean. Univariate analysis was initially performed, followed by multivariable analysis (adjusted odds ratios with 95% confidence intervals).

Results: The study included a total of 1181 women attempting trial of labor after cesarean after 2 previous cesarean deliveries. Among these cases, vaginal birth after cesarean was achieved in 973 women (82.4%). Women with failed trial of labor after cesarean had higher rates of maternal and neonatal morbidities. Several factors were found to be associated with failed trial of labor after cesarean, including longer interpregnancy and interdelivery intervals, lower gravidity and parity, lower rates of previous successful vaginal delivery, smoking, earlier gestational age at delivery (38.3±2.1 vs 39.5±1.3 weeks), late preterm delivery (34-37 weeks of gestation), lower cervical dilation on admission, no use of epidural, and smaller neonatal birthweight. Our multivariable model revealed that late preterm delivery (adjusted odds ratio, 3.79; 95% confidence interval, 1.37-10.47) and cervical dilation on admission for labor <3 cm (adjusted odds ratio, 2.58; 95% confidence interval, 1.47-4.54) were associated with higher odds of failed trial of labor after cesarean.

Conclusion: In the investigated population of women with 2 previous cesarean deliveries undergoing trial of labor after cesarean, admission at the late preterm period with a cervical dilation of <3 cm, which reflects the latent phase, may elevate the risk of failed trial of labor after cesarean and a repeated intrapartum cesarean delivery.

Keywords: 2 previous cesarean deliveries; cesarean delivery; maternal morbidity; multicenter study; neonatal morbidity; obstetrical outcomes; preterm delivery; trial of labor after cesarean; trial of labor after cesarean success; vaginal birth after cesarean.