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Factors Associated with Successful Trial of Labor after Cesarean Section: A Retrospective Cohort Study

OBJECTIVE: To determine the effectiveness of trial of labor after cesarean section (TOLAC) and the factors associated with a successful TOLAC. MATERIALS AND METHODS: A retrospective cohort study was conducted on consecutive singleton pregnancies with a previous single low-transverse cesarean section...

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Autores principales: Thapsamuthdechakorn, Aram, Sekararithi, Ratanaporn, Tongsong, Theera
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6008842/
https://www.ncbi.nlm.nih.gov/pubmed/29967697
http://dx.doi.org/10.1155/2018/6140982
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author Thapsamuthdechakorn, Aram
Sekararithi, Ratanaporn
Tongsong, Theera
author_facet Thapsamuthdechakorn, Aram
Sekararithi, Ratanaporn
Tongsong, Theera
author_sort Thapsamuthdechakorn, Aram
collection PubMed
description OBJECTIVE: To determine the effectiveness of trial of labor after cesarean section (TOLAC) and the factors associated with a successful TOLAC. MATERIALS AND METHODS: A retrospective cohort study was conducted on consecutive singleton pregnancies with a previous single low-transverse cesarean section planned for TOLAC at a tertiary teaching hospital. The potential risk factors of a successful TOLAC were compared with those associated with a failed TOLAC. A simple audit system used in the first two years was also taken into account in the analysis as a potential factor for success. RESULTS: During the study period, 2,493 women were eligible for TOLAC and 704 of them were scheduled for TOLAC, but finally 592 underwent TOLAC. Among them, 355 (60%) had a successful vaginal birth and 237 (40%) had a failed TOLAC. The independent factors associated with the success rate included the audit system, prior vaginal birth, low maternal BMI, and lower birth weight or gestational age, whereas induction of labor and recurring indications in previous pregnancy significantly increased the risk of having a failed TOLAC. Strikingly, the strongest predictor of a successful TOLAC was the audit system with OR of 6.4 (95%CI: 3.9-10.44), followed by a history of vaginal birth in previous pregnancies (OR: 3.2; 95%CI: 1.87-5.36). CONCLUSION: The simple audit system had the greatest impact on the success rate of TOLAC, instead of the less powerful obstetrical factors as reported in previous reports. The audit system is the only potential factor that could be strengthened to improve the success rate.
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spelling pubmed-60088422018-07-02 Factors Associated with Successful Trial of Labor after Cesarean Section: A Retrospective Cohort Study Thapsamuthdechakorn, Aram Sekararithi, Ratanaporn Tongsong, Theera J Pregnancy Research Article OBJECTIVE: To determine the effectiveness of trial of labor after cesarean section (TOLAC) and the factors associated with a successful TOLAC. MATERIALS AND METHODS: A retrospective cohort study was conducted on consecutive singleton pregnancies with a previous single low-transverse cesarean section planned for TOLAC at a tertiary teaching hospital. The potential risk factors of a successful TOLAC were compared with those associated with a failed TOLAC. A simple audit system used in the first two years was also taken into account in the analysis as a potential factor for success. RESULTS: During the study period, 2,493 women were eligible for TOLAC and 704 of them were scheduled for TOLAC, but finally 592 underwent TOLAC. Among them, 355 (60%) had a successful vaginal birth and 237 (40%) had a failed TOLAC. The independent factors associated with the success rate included the audit system, prior vaginal birth, low maternal BMI, and lower birth weight or gestational age, whereas induction of labor and recurring indications in previous pregnancy significantly increased the risk of having a failed TOLAC. Strikingly, the strongest predictor of a successful TOLAC was the audit system with OR of 6.4 (95%CI: 3.9-10.44), followed by a history of vaginal birth in previous pregnancies (OR: 3.2; 95%CI: 1.87-5.36). CONCLUSION: The simple audit system had the greatest impact on the success rate of TOLAC, instead of the less powerful obstetrical factors as reported in previous reports. The audit system is the only potential factor that could be strengthened to improve the success rate. Hindawi 2018-06-03 /pmc/articles/PMC6008842/ /pubmed/29967697 http://dx.doi.org/10.1155/2018/6140982 Text en Copyright © 2018 Aram Thapsamuthdechakorn et al. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Thapsamuthdechakorn, Aram
Sekararithi, Ratanaporn
Tongsong, Theera
Factors Associated with Successful Trial of Labor after Cesarean Section: A Retrospective Cohort Study
title Factors Associated with Successful Trial of Labor after Cesarean Section: A Retrospective Cohort Study
title_full Factors Associated with Successful Trial of Labor after Cesarean Section: A Retrospective Cohort Study
title_fullStr Factors Associated with Successful Trial of Labor after Cesarean Section: A Retrospective Cohort Study
title_full_unstemmed Factors Associated with Successful Trial of Labor after Cesarean Section: A Retrospective Cohort Study
title_short Factors Associated with Successful Trial of Labor after Cesarean Section: A Retrospective Cohort Study
title_sort factors associated with successful trial of labor after cesarean section: a retrospective cohort study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6008842/
https://www.ncbi.nlm.nih.gov/pubmed/29967697
http://dx.doi.org/10.1155/2018/6140982
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