Neonatal outcomes following a trial of labor after Caesarean delivery: a population-based study. (18th August 2018)

• Record Type: Journal Article
• Authors: Litwin, Charles Edward; Czuzoj-Shulman, Nicholas; Zakhari, Andrew; Abenhaim, Haim Arie
• Is Part Of: Journal of maternal-fetal & neonatal medicine. Volume 31:Number 16(2018)
• Page Start: 2148
• Page End: 2154
• Publication Date: 2018-08-18
• Subjects: Adverse neonatal outcomes -- Caesarean section -- elective repeat Caesarean delivery -- trial of labor after Caesarean -- vaginal birth after Caesarean; Obstetrics -- Periodicals; Perinatology -- Periodicals; Infants (Newborn) -- Diseases -- Periodicals; Neonatology -- Periodicals; 618.2
• DOI: 10.1080/14767058.2017.1337740
• Languages: English
• ISSNs: 1476-7058

Abstract

Abstract: Purpose: To evaluate the neonatal effects of trial of labor after Caesarean (TOLAC) births. Methods: We conducted a retrospective population-based cohort study using the CDC's Period Linked Birth/Infant Death Public Use File (2011–2013) on women with a live singleton pregnancy and prior Caesarean delivery. Multivariate logistic regression compared neonatal outcomes between women who underwent a TOLAC with women who did not. Secondary analysis compared outcomes of birth with uterine rupture to those without. Results: A total of 1, 036, 554 births met inclusion criteria, of which 17.5% underwent TOLAC. Women who had a TOLAC were more likely to deliver infants requiring neonatal intensive care unit (NICU) admission (odds ratios (OR) 1.12, 95%CI 1.09–1.16) and assisted ventilation (OR 1.07, 95%CI 1.03–1.12). Among women with TOLAC, 0.18% of births were in context of a uterine rupture and those neonates had an increased risk of NICU admissions (OR 5.95, 95%CI 4.56–7.76), assisted ventilation (OR 8.89, 95%CI 6.73–11.75), seizures (OR 91.66, 95%CI 42.23–198.93), and death (OR 16.28, 95%CI 5.09–52.08). Conclusions: Neonatal morbidity appears slightly increased among women with a TOLAC. However, morbidity and mortality are considerably increased in cases of uterine rupture. Appropriate selection and counseling of women for TOLAC should be undertaken as to minimize uterine rupture risk.