Delivery Progress, Labor Interventions and Perinatal Outcome in Spontaneous Vaginal Delivery of Singleton Pregnancies between Nulliparous and Primiparous Women with One Previous Elective Cesarean Section: A Retrospective Comparative Study
Trial of labor after cesarean (TOLAC) is an alternative to repeated cesarean for women with singleton pregnancy and one previous transverse lower segment cesarean section (LSCS), resulting in most cases being a successful vaginal birth after cesarean section (VBAC). The primary objective of this stu...
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MDPI AG
2023-10-01
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| author | Grigorios Karampas Martin Witkowski Dimitra Metallinou Margareta Steinwall Alkis Matsas Theodoros Panoskaltsis Panagiotis Christopoulos |
| author_facet | Grigorios Karampas Martin Witkowski Dimitra Metallinou Margareta Steinwall Alkis Matsas Theodoros Panoskaltsis Panagiotis Christopoulos |
| author_sort | Grigorios Karampas |
| collection | DOAJ |
| description | Trial of labor after cesarean (TOLAC) is an alternative to repeated cesarean for women with singleton pregnancy and one previous transverse lower segment cesarean section (LSCS), resulting in most cases being a successful vaginal birth after cesarean section (VBAC). The primary objective of this study was to examine if the progress and the duration of the active first stage and the second stage of labor in nulliparous women with singleton pregnancy, spontaneous start of labor and vaginal birth differ from primiparous women succeeding VBAC after one previous elective LSCS in a country with a low cesarean section and high VBAC rate. Secondary objectives were to compare labor interventions and maternal–neonatal outcomes between the two groups. Methods: This is a retrospective comparative study. Data were collected in a four-year period at the departments of Obstetrics and Gynecology at Kristianstad and Ystad hospitals in Sweden. Out of 14,925 deliveries, 106 primipara women with one previous elective LSCS and a spontaneous labor onset in the subsequent singleton pregnancy were identified. Of these women, 94 (88.7%) delivered vaginally and were included in the study (VBAC group). The comparison group included 212 randomly selected nulliparous women that had a normal singleton pregnancy, spontaneous labor onset and delivered vaginally. Results: The rate of cervical dilation during the active first stage of labor as well as the duration of the second stage did not differ between the two groups. When adjusting for cervical dilation at admission, there was no significant difference between the two groups regarding the duration of the active phase of the first stage of labor. No significant differences were found in maternal–neonatal outcomes between the two groups except for higher birth weight in the VBAC group. The use of epidural analgesia was associated with slower dilation rhythm over the duration of the active phase and second stage of labor, need for labor augmentation, postpartum bleeding and need for transfusion at higher rates, irrespective of parity when epidural was used. Conclusions: Our study provides evidence that in women with one previous elective LSCS undergoing TOLAC in the subsequent pregnancy resulting in vaginal birth, the progress and duration of labor are not different from those in nulliparous women when labor is spontaneous and the it is a singleton pregnancy. The use of epidural was associated with prolonged labor, need for labor augmentation and higher postpartum bleeding, irrespective of parity. This information may be useful in patient counseling and labor management in TOLAC. |
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| spelling | doaj.art-873021b493f648abbf2e409bafef049d2023-11-19T17:06:12ZengMDPI AGLife2075-17292023-10-011310201610.3390/life13102016Delivery Progress, Labor Interventions and Perinatal Outcome in Spontaneous Vaginal Delivery of Singleton Pregnancies between Nulliparous and Primiparous Women with One Previous Elective Cesarean Section: A Retrospective Comparative StudyGrigorios Karampas0Martin Witkowski1Dimitra Metallinou2Margareta Steinwall3Alkis Matsas4Theodoros Panoskaltsis5Panagiotis Christopoulos6Department of Obstetrics and Gynecology, Skånes University Hospital, 21428 Malmö-Lund, SwedenDepartment of Obstetrics and Gynecology, Kristianstad/Ystad Community Hospitals, 27133 Ystad, SwedenDepartment of Midwifery, University of West Attica, 12243 Athens, GreeceDepartment of Obstetrics and Gynecology, Kristianstad/Ystad Community Hospitals, 27133 Ystad, SwedenSecond Department of Obstetrics & Gynecology, Medical School, University of Athens “Aretaieion” Hospital, 11528 Athens, GreeceSecond Department of Obstetrics & Gynecology, Medical School, University of Athens “Aretaieion” Hospital, 11528 Athens, GreeceSecond Department of Obstetrics & Gynecology, Medical School, University of Athens “Aretaieion” Hospital, 11528 Athens, GreeceTrial of labor after cesarean (TOLAC) is an alternative to repeated cesarean for women with singleton pregnancy and one previous transverse lower segment cesarean section (LSCS), resulting in most cases being a successful vaginal birth after cesarean section (VBAC). The primary objective of this study was to examine if the progress and the duration of the active first stage and the second stage of labor in nulliparous women with singleton pregnancy, spontaneous start of labor and vaginal birth differ from primiparous women succeeding VBAC after one previous elective LSCS in a country with a low cesarean section and high VBAC rate. Secondary objectives were to compare labor interventions and maternal–neonatal outcomes between the two groups. Methods: This is a retrospective comparative study. Data were collected in a four-year period at the departments of Obstetrics and Gynecology at Kristianstad and Ystad hospitals in Sweden. Out of 14,925 deliveries, 106 primipara women with one previous elective LSCS and a spontaneous labor onset in the subsequent singleton pregnancy were identified. Of these women, 94 (88.7%) delivered vaginally and were included in the study (VBAC group). The comparison group included 212 randomly selected nulliparous women that had a normal singleton pregnancy, spontaneous labor onset and delivered vaginally. Results: The rate of cervical dilation during the active first stage of labor as well as the duration of the second stage did not differ between the two groups. When adjusting for cervical dilation at admission, there was no significant difference between the two groups regarding the duration of the active phase of the first stage of labor. No significant differences were found in maternal–neonatal outcomes between the two groups except for higher birth weight in the VBAC group. The use of epidural analgesia was associated with slower dilation rhythm over the duration of the active phase and second stage of labor, need for labor augmentation, postpartum bleeding and need for transfusion at higher rates, irrespective of parity when epidural was used. Conclusions: Our study provides evidence that in women with one previous elective LSCS undergoing TOLAC in the subsequent pregnancy resulting in vaginal birth, the progress and duration of labor are not different from those in nulliparous women when labor is spontaneous and the it is a singleton pregnancy. The use of epidural was associated with prolonged labor, need for labor augmentation and higher postpartum bleeding, irrespective of parity. This information may be useful in patient counseling and labor management in TOLAC.https://www.mdpi.com/2075-1729/13/10/2016TOLACVBACsingleton pregnancynulliparousprimiparaspontaneous labor |
| spellingShingle | Grigorios Karampas Martin Witkowski Dimitra Metallinou Margareta Steinwall Alkis Matsas Theodoros Panoskaltsis Panagiotis Christopoulos Delivery Progress, Labor Interventions and Perinatal Outcome in Spontaneous Vaginal Delivery of Singleton Pregnancies between Nulliparous and Primiparous Women with One Previous Elective Cesarean Section: A Retrospective Comparative Study Life TOLAC VBAC singleton pregnancy nulliparous primipara spontaneous labor |
| title | Delivery Progress, Labor Interventions and Perinatal Outcome in Spontaneous Vaginal Delivery of Singleton Pregnancies between Nulliparous and Primiparous Women with One Previous Elective Cesarean Section: A Retrospective Comparative Study |
| title_full | Delivery Progress, Labor Interventions and Perinatal Outcome in Spontaneous Vaginal Delivery of Singleton Pregnancies between Nulliparous and Primiparous Women with One Previous Elective Cesarean Section: A Retrospective Comparative Study |
| title_fullStr | Delivery Progress, Labor Interventions and Perinatal Outcome in Spontaneous Vaginal Delivery of Singleton Pregnancies between Nulliparous and Primiparous Women with One Previous Elective Cesarean Section: A Retrospective Comparative Study |
| title_full_unstemmed | Delivery Progress, Labor Interventions and Perinatal Outcome in Spontaneous Vaginal Delivery of Singleton Pregnancies between Nulliparous and Primiparous Women with One Previous Elective Cesarean Section: A Retrospective Comparative Study |
| title_short | Delivery Progress, Labor Interventions and Perinatal Outcome in Spontaneous Vaginal Delivery of Singleton Pregnancies between Nulliparous and Primiparous Women with One Previous Elective Cesarean Section: A Retrospective Comparative Study |
| title_sort | delivery progress labor interventions and perinatal outcome in spontaneous vaginal delivery of singleton pregnancies between nulliparous and primiparous women with one previous elective cesarean section a retrospective comparative study |
| topic | TOLAC VBAC singleton pregnancy nulliparous primipara spontaneous labor |
| url | https://www.mdpi.com/2075-1729/13/10/2016 |
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