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Prediction Factors for Successful Trial of Labor After Cesarean Delivery: A Retrospective Cohort Study
Abstract Number: F4B-4
Abstract Type: Original Research
Our previous data of nulliparous parturients demonstrated that labor analgesia characteristics could be suggestive of failed labor process. Cesarean delivery (CD) rates are increasing world-wide, uterine scars caused by previous CS increase accordingly. Guideline suggest it is reasonable and safe for women with a prior CS to choose vaginal labor. However, when trial of labor after cesarean (TOLAC) fails, the risks of maternal morbidity and neonatal complications are higher than after elective repeat CD (ERCD). The aim of this study is to screen for factors to predict successful TOLAC and thus to reduce maternal and fetal adverse outcomes.
We retrospectively reviewed the records of parturients who chose TOLAC from 6/1/2015 to 3/1/2017. Two groups were divided according to the success and failure of TOLAC. Demographic data, anesthesia type, time of epidural placement and membrane rupture were record. Newborn weight, head circumference and Apgar scores were also documented.
Among all maternal characteristics, after adjusting for multiple comparisons using Bonferroni methods, we found that maternal BMI, time interval from labor analgesia to push or OR period, and membrane rupture to delivery period were significantly different between the two groups. After adjusting for multiple using Bonferroni methods, these three characteristics were still significantly different between groups. We found that 5-min Apgar scores (unadjusted p-value<0.0001, adjusted p-value<0.0001) and head circumference (unadjusted p-value=0.0065, adjusted p-value=0.0260) were significantly different between the two groups.
Our data identified 3 physical measurable and/or estimable data elements, i.e. the maternal BMI, baby weight and head circumference as risk factors for failed TOLAC. As a novel finding, we identified both of the time periods of the labor process (from rupture of membrane to push/CD) and the length of labor analgesia epidural more than doubled in the failed TOLAC group suggesting that the prolonged labor process could also be useful surrogate to predict failure. The higher Apgar scores in the successful vaginal delivery group further implied that a preventive elective CD in the prolonged TOLAC group could be potentially beneficial. Further study is in the process to stratify the balance of risk and benefit for this special group of parturients.
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