Operative Vaginal Delivery Is a Safe Option in Women Undergoing a Trial of Labor after Cesarean
Abstract Objective To compare outcomes of operative intervention in the second stage of labor during trial of labor after cesarean (TOLAC). Study Design A secondary analysis of the Maternal-Fetal Medicine Units Network cesarean section registry was conducted. Analysis was b...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Thieme Medical Publishers, Inc.
2019-04-01
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| Series: | American Journal of Perinatology Reports |
| Subjects: | |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0039-1692482 |
| _version_ | 1818962249344090112 |
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| author | Erin Krizman Patricia Grzebielski Kathleen M. Antony Emmanuel Sampene Matthew Shanahan J. Igor Iruretagoyena Justin Bohrer |
| author_facet | Erin Krizman Patricia Grzebielski Kathleen M. Antony Emmanuel Sampene Matthew Shanahan J. Igor Iruretagoyena Justin Bohrer |
| author_sort | Erin Krizman |
| collection | DOAJ |
| description | Abstract
Objective To compare outcomes of operative intervention in the second stage of labor during trial of labor after cesarean (TOLAC).
Study Design A secondary analysis of the Maternal-Fetal Medicine Units Network cesarean section registry was conducted. Analysis was by first attempted mode of delivery.
Results A total of 1,837 met inclusion criteria. Subjects in the operative vaginal groups (OVDs) were more likely to have a prior vaginal delivery (vacuum 34.2%; forceps 34.3%) than the repeat cesarean delivery (RCD) group (22.6%; p < 0.0001). Most OVD attempts were successful (forceps 90.4%; vacuum 92.6%). Neonatal morbidity was not different (12.1% forceps vs. 14.6% vacuum; 14.8% RCD). Maternal morbidity was highest among forceps deliveries (32.3 vs. 24.3% vacuum; 22.0% RCD, p = 0.0001). RCD was associated with surgical injury (2.7 vs. 0.7% forceps; 0% vacuum; p < 0.0001), endometritis (8.4 vs. 3.2% forceps, 1.2% vacuum; p < 0.0001), and wound complications (1.9 vs. 0.4% forceps; 0.3% vacuum; p = 0.006). OVD was associated with anal sphincter laceration (22.7% forceps, 15.5% vacuum; 0% RCD; p = 0.01).
Conclusion The success rate of OVD is high in TOLAC with similar outcomes to RCD. Maternal composite outcomes were highest with forceps-assisted vaginal deliveries. However, considering overall morbidity, OVD in the second stage of labor in TOLAC is a reasonable, safe option in selected cases. |
| first_indexed | 2024-12-20T12:26:19Z |
| format | Article |
| id | doaj.art-d5d750ca02e749d094f0717934b91e83 |
| institution | Directory Open Access Journal |
| issn | 2157-6998 2157-7005 |
| language | English |
| last_indexed | 2024-12-20T12:26:19Z |
| publishDate | 2019-04-01 |
| publisher | Thieme Medical Publishers, Inc. |
| record_format | Article |
| series | American Journal of Perinatology Reports |
| spelling | doaj.art-d5d750ca02e749d094f0717934b91e832022-12-21T19:40:52ZengThieme Medical Publishers, Inc.American Journal of Perinatology Reports2157-69982157-70052019-04-010902e190e19410.1055/s-0039-1692482Operative Vaginal Delivery Is a Safe Option in Women Undergoing a Trial of Labor after CesareanErin Krizman0Patricia Grzebielski1Kathleen M. Antony2Emmanuel Sampene3Matthew Shanahan4J. Igor Iruretagoyena5Justin Bohrer6Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WisconsinDivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WisconsinDivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WisconsinDivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WisconsinDepartment of Obstetrics and Gynecology, Barnes-Jewish Hospital, Washington University in St. Louis, St. Louis, MissouriDivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WisconsinDivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WisconsinAbstract Objective To compare outcomes of operative intervention in the second stage of labor during trial of labor after cesarean (TOLAC). Study Design A secondary analysis of the Maternal-Fetal Medicine Units Network cesarean section registry was conducted. Analysis was by first attempted mode of delivery. Results A total of 1,837 met inclusion criteria. Subjects in the operative vaginal groups (OVDs) were more likely to have a prior vaginal delivery (vacuum 34.2%; forceps 34.3%) than the repeat cesarean delivery (RCD) group (22.6%; p < 0.0001). Most OVD attempts were successful (forceps 90.4%; vacuum 92.6%). Neonatal morbidity was not different (12.1% forceps vs. 14.6% vacuum; 14.8% RCD). Maternal morbidity was highest among forceps deliveries (32.3 vs. 24.3% vacuum; 22.0% RCD, p = 0.0001). RCD was associated with surgical injury (2.7 vs. 0.7% forceps; 0% vacuum; p < 0.0001), endometritis (8.4 vs. 3.2% forceps, 1.2% vacuum; p < 0.0001), and wound complications (1.9 vs. 0.4% forceps; 0.3% vacuum; p = 0.006). OVD was associated with anal sphincter laceration (22.7% forceps, 15.5% vacuum; 0% RCD; p = 0.01). Conclusion The success rate of OVD is high in TOLAC with similar outcomes to RCD. Maternal composite outcomes were highest with forceps-assisted vaginal deliveries. However, considering overall morbidity, OVD in the second stage of labor in TOLAC is a reasonable, safe option in selected cases.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0039-1692482trial of labor after cesareanoperative vaginal deliveryforceps deliveryvacuum-assisted deliveryvaginal birthcesarean delivery |
| spellingShingle | Erin Krizman Patricia Grzebielski Kathleen M. Antony Emmanuel Sampene Matthew Shanahan J. Igor Iruretagoyena Justin Bohrer Operative Vaginal Delivery Is a Safe Option in Women Undergoing a Trial of Labor after Cesarean American Journal of Perinatology Reports trial of labor after cesarean operative vaginal delivery forceps delivery vacuum-assisted delivery vaginal birth cesarean delivery |
| title | Operative Vaginal Delivery Is a Safe Option in Women Undergoing a Trial of Labor after Cesarean |
| title_full | Operative Vaginal Delivery Is a Safe Option in Women Undergoing a Trial of Labor after Cesarean |
| title_fullStr | Operative Vaginal Delivery Is a Safe Option in Women Undergoing a Trial of Labor after Cesarean |
| title_full_unstemmed | Operative Vaginal Delivery Is a Safe Option in Women Undergoing a Trial of Labor after Cesarean |
| title_short | Operative Vaginal Delivery Is a Safe Option in Women Undergoing a Trial of Labor after Cesarean |
| title_sort | operative vaginal delivery is a safe option in women undergoing a trial of labor after cesarean |
| topic | trial of labor after cesarean operative vaginal delivery forceps delivery vacuum-assisted delivery vaginal birth cesarean delivery |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0039-1692482 |
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