Download PDF
Am J Perinatol
DOI: 10.1055/a-2699-9313
Original Article

Maternal and Perinatal Outcomes following Trial of Labor After Cesarean in Women with previous Term Cesarean Delivery and Chorioamnionitis

Authors

  • Maayan Bas Lando    ‡

    1   Department of Obstetrics and Gynecology, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel

  • Aviya Dror   ‡

    2   Adelson School of Medicine, Ariel University, Ariel, Israel

  • Rivka Farkash

    1   Department of Obstetrics and Gynecology, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel

  • Misgav Rottenstreich 

    1   Department of Obstetrics and Gynecology, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel

  • Tehila Avitan

    1   Department of Obstetrics and Gynecology, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel

  • Sorina Grisaru-Granovsky

    1   Department of Obstetrics and Gynecology, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel

  • Hen Y. Sela 

    1   Department of Obstetrics and Gynecology, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
Further Information
Also available at
   Permissions and Reprints
Preview

Abstract

Objective

This study aimed to evaluate maternal and neonatal outcomes of women who had chorioamnionitis during their primary term cesarean delivery (CD), in their subsequent delivery.

Study Design

This multicenter retrospective cohort study (2005–2022) included women who attempted trial of labor after CD (TOLAC) following a primary term emergency CD. Women were grouped by the presence or absence of chorioamnionitis at the primary CD. Primary outcome was mode of delivery in the subsequent delivery. Secondary outcomes included adverse maternal and neonatal outcomes, including uterine rupture and adhesions. Multivariable logistic regression identified predictors of recurrent chorioamnionitis and adverse outcomes.

Results

Of 2,626 women included, 258 (9.8%) had chorioamnionitis during their primary CD (Chorio-PCD). In the subsequent delivery, this group as opposed to women without chorioamnionitis, had higher rates of emergency repeat CD (31.4 vs. 24.3%, p = 0.012), recurrent chorioamnionitis (14.3 versus 5.1%, p < 0.001), and postpartum readmission (2.3 vs. 0.5%, p = 0.006). Nevertheless, having previous chorioamnionitis did not impact the rate of uterine rupture among women who attempted TOLAC. Among women undergoing repeat non-elective CD, rates of severe adhesions (38.3 vs. 25.6%, p = 0.016) and postpartum hemorrhage (13.6 vs. 6.9%, p = 0.034) were significantly higher in the Chorio-PCD group. Chorio-PCD in previous pregnancy independently predicted composite adverse maternal outcome (aOR = 1.50, 95% CI: 1.13–1.99, p = 0.005).

Conclusion

Chorioamnionitis at primary term CD is associated with increased maternal morbidity in subsequent delivery. These findings support the need for careful delivery planning and postpartum management in this population.

Key Points

  • Chorio-PCD linked to emergency CD in univariate, but not in multivariate, analysis.

  • Chorio-PCD was significantly associated with adverse maternal outcomes at the subsequent delivery.

  • Chorio-PCD was not associated with increased risk of preterm delivery or uterine rupture.

Keywords

chorioamnionitis - cesarean delivery - pregnancy complications - uterine rupture - adhesions

Contributors Statement

All authors contributed substantially to the work reported. M.B.L. and H.Y.S.: conceptualization; H.Y.S.: methodology; R.F.: software; A.D. and M.B.L.: validation; R.F.: formal analysis; R.F. and M.B.L.: investigation; R.F. and M.B.L.: resources; A.D. and M.B.L.: data curation; H.Y.S., A.D., and M.B.L.: writing—original draft preparation; S.G.G., M.R., and T.A.: writing—review and editing; H.Y.S., M.B.L., and A.D.: visualization; H.Y.S. and S.G.G.: supervision; H.Y.S. and M.B.L.: project administration. All authors have read and agreed to the published version of the manuscript.


Data Availability Statement

The deidentified dataset will be made available upon reasonable request.


Ethical Approval

The study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethics Committees of SZMC and BCH (approval number: 0028–24-SZMC). The study approval date was March 18, 2024.


Informed Consent

Patient consent was waived due to the historical study design.


‡ These authors contributed equally to this article.


Note

This work was carried out as part of the requirements of the Adelson school of medicine in Ariel for the MD degree.




Publication History

Received: 20 July 2025

Accepted: 09 September 2025

Article published online:
22 September 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA