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Trial of labor after cesarean in twin gestation with no prior vaginal delivery – evidence from largest cohort reported

OBJECTIVE: To investigate trial of labor after cesarean (TOLAC) success rates in twin gestations with no prior vaginal delivery. METHODS: A retrospective study of women with twin gestations who underwent a TOLAC and had no prior vaginal delivery during 2011–2020. TOLAC success and failure groups wer...

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Detalles Bibliográficos
Autores principales: Levin, Gabriel, Yagel, Simcha, Schwartz, Anat, Many, Ariel, Rosenbloom, Joshua I., Yinon, Yoav, Meyer, Raanan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9544935/
https://www.ncbi.nlm.nih.gov/pubmed/34995363
http://dx.doi.org/10.1002/ijgo.14090
Descripción
Sumario:OBJECTIVE: To investigate trial of labor after cesarean (TOLAC) success rates in twin gestations with no prior vaginal delivery. METHODS: A retrospective study of women with twin gestations who underwent a TOLAC and had no prior vaginal delivery during 2011–2020. TOLAC success and failure groups were compared. RESULTS: Of 675 twin gestations with a history of cesarean delivery and no prior vaginal delivery, 83 (12.3%) elected to undergo a TOLAC and 26 (31.3%) succeeded. Two (7.7%) women delivered by cesarean for the second twin after vaginal delivery of the first twin. Epidural analgesia was positively associated with TOLAC success (odds ratio [OR] 4.31, 95% confidence interval [CI] 1.56–11.94, P = 0.004). Uterine rupture occurred in two patients (3.5%) of the TOLAC failure group. The proportion of cases with low Apgar score (<7) at 5 min was higher in the TOLAC success group (4 [15.4%] versus 1 [1.8%]; OR 10.1, 95% CI 1.07–96.22, P = 0.032) and the neonatal composite adverse outcome rate was lower in this group (OR 0.22, 95% CI 0.07–0.69, P = 0.009). CONCLUSION: TOLAC in women with twins with no prior vaginal delivery is associated with a low success rate. No independent predictors of successful TOLAC were identified.