Am J Perinatol 2017; 34(08): 765-773
DOI: 10.1055/s-0037-1598080
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Outcomes of Operative Vaginal Delivery during Trial of Labor after Cesarean Delivery

Clifton O. Brock
1  Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York
,
Shravya Govindappagari
1  Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York
,
Cynthia Gyamfi-Bannerman
1  Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York
› Author Affiliations
Further Information

Publication History

06 December 2016

16 December 2016

Publication Date:
31 January 2017 (online)

Abstract

Objective The objective of this study is to determine the maternal and neonatal morbidity associated with attempting operative vaginal delivery (OVD) compared with the alternative of a laboring repeat cesarean delivery (LRCD) in women attempting a trial of labor after cesarean delivery (TOLAC).

Methods This is a secondary analysis of a multicenter prospective study designed to assess perinatal outcomes of OVD in women with a prior uterine scar. The study includes women who attempted TOLAC and reached +2 station with a fully dilated cervix. Composites on neonatal and maternal morbidity were compared between women in whom OVD was attempted and those who underwent LRCD by fitting multivariate logistic regression models.

Results In total, 6,489 women attempting TOLAC reached 2+ station with a fully dilated cervix. Of these, 5,640 (86.9%) had a spontaneous vaginal delivery, 762 (11.7%) underwent attempted OVD, and 87 (1.3%) had an LRCD. Compared with attempting OVD, LRCD was associated with greater neonatal morbidity (odds ratio [OR]: 2.41; 95% confidence interval [CI]: 1.13–5.15) and less maternal morbidity (OR: 0.28; 95% CI: 0.14–0.55). Maternal morbidity of OVD is driven by perineal injury.

Conclusion In laboring women with a previous uterine scar, attempting OVD is associated with greater maternal and less neonatal morbidity than LRCD.

Note

Findings from this manuscript were presented at the 36th Annual Pregnancy Meeting of the Society for Maternal Fetal Medicine in Atlanta, Georgia, January 2, 2016, to June 2, 2016, Abstract #379. Reprints are not available.