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CME Credit Offered
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Poster Session 2

(551) Obstetric, Maternal and Neonatal Outcomes Associated with Attempted Trial of Labor after Cesarean Delivery

Thursday, January 30, 2025
4:00 PM – 6:00 PM  

    Submitting Author and Presenting Author(s)

  • Marlee Hirsch, MD (she/her/hers)

    Northwell Lenox Hill Hospital
    Lenox Hill Hospital, New York, United States

    • Coauthor(s)

  • EL

    Erez Lenchner, PhD

    Biostatistics and Data Management
    New York University Rory Meyers College of Nursing
    New York, New York, United States

  • Ashley Zimmermann, MD (she/her/hers)

    Resident
    Northwell Lenox Hill Hospital
    New York, New York, United States

  • Moti Gulersen, MD, MSc

    Assistant Professor, Obstetrics and Gynecology
    Sidney Kimmel Medical College of Thomas Jefferson University
    Philadelphia, Pennsylvania, United States

  • Eran Bornstein, MD

    Vice Chair of Obstetrics
    Northwell Lenox Hill Hospital
    New Hyde Park, New York, United States

Objective: To examine the obstetric, maternal, and neonatal outcomes associated with attempted trial of labor after cesarean delivery (TOLAC) in the United States (US).

Study Design: A retrospective analysis of the Centers for Disease Control and Prevention’s Natality live birth database (2016-2022). The inclusion criteria consisted of term (37 0/7 - 40 6/7 weeks), singleton pregnancies with a history of cesarean delivery. The study group comprised of individuals who attempted TOLAC, while the comparison group consisted of those undergoing repeat cesarean section without TOLAC. Obstetric, maternal, and neonatal outcomes were compared between the two groups using Pearson’s chi-square test. Results were presented as odds ratios (OR) with 95% confidence intervals (CI). Statistical significance was defined as p-value < 0.05.

Results: Of the 7,250,494 live births with previous cesarean sections analyzed, 2,313,494 (31.9%) individuals attempted TOLAC. The prevalence of attempted TOLAC and the ORs based on different maternal and neonatal outcomes are presented in Tables 1 and 2, respectively.  

Conclusion: Based on this large contemporary US database, we provide an update on obstetric, maternal, and neonatal outcomes associated with attempted TOLAC. Attempted TOLAC was associated with a higher risk of maternal intensive care unit (ICU) admission, maternal antibiotic use, uterine rupture, immediate neonatal assisted ventilation, and 5-minute APGAR scores < 7. However, attempted TOLAC was associated with lower odds of assisted neonatal ventilation after six hours and neonatal ICU admissions, suggesting that attempted TOLAC has a transient impact on the neonatal status. These findings can be used to help counsel patients on risks of attempting TOLAC.