Vaginal Birth after Two Previous Cesarean Sections versus Elective Repeated Cesarean: A Retrospective Study
Objective Trial of labor after cesarean delivery (TOLAC) is a common practice worldwide but the evidence is still scant regarding this practice in women who underwent 2 previous cesareans. The purpose of this study is to retrospectively review our experience with vaginal birth after two previous cesarean sections (VBA2C), with specific attention to the indications for previous cesarean and to the women's motivation for attempting trial of labor.
Study Design This was a retrospective cohort study conducted in a primary care hospital between January 2011 and December 2019. Inclusion criteria were: singleton pregnancies, absence of morphological abnormalities at ultrasonographic screening of the second trimester (or at any other stage of pregnancy), and two previous cesarean sections.
Results The final analysis included 114 cases for maternal and neonatal outcomes. In total, 40.4% of women chose trial of labor after two cesarean delivery (TOLA2C group). TOLA2C was associated with a success rate of 76.1%, a higher gestational age at birth, and a shorter hospital stay, compared with elective repeated cesarean delivery group. There were no significant differences in the rate of Apgar scores at 5 minutes <7 between both groups. The percentage of successful TOLA2C in women with prior vaginal delivery was 92.8%. Factors related to failed TOLA2C included failure to progress (3/11, 27.3%), nonreassuring fetal heart rate (3/11, 27.3%), and no onset of spontaneous labor after premature rupture of membranes (5/11, 45.4%). In the group of TOLA2C, more than 70% accepted to travel more than 45 minutes to reach our hospital, with the aim to attempt VBA2C.
Conclusion TOLA2C is a possible option for both mothers and neonates in selected cases. Adequate counseling about pros and cons of TOLA2C is mandatory. The woman's motivation represents a key element to determine the success of VBA2C.
Selection of candidates and motivation of the patients represent key elements for successful TOLA2C.
A careful record of obstetrical history and previous deliveries can provide clinicians useful information.
Mode of delivery in women with two previous cesareans is strongly associated with doctor's counseling.
Keywordsvaginal birth after cesarean - trial of labor - uterine rupture - elective repeated cesarean delivery
08 September 2020 (online)
Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.
- 1 Healthy People. 2020 . Available at: http://www.healthypeople.gov/2020/topicsob . Accessed June 2, 2020
- 2 Denham SH, Humphrey T, deLabrusse C, Dougall N. Mode of birth after caesarean section: individual prediction scores using Scottish population data. BMC Pregnancy Childbirth 2019; 19 (01) 84
- 3 Talaulikar VS, Arulkumaran S. Vaginal birth after caesarean section. Obstet Gynaecol Reprod Med 2015; 27 (07) 195-202
- 4 Martel MJ, MacKinnon CJ. No. 155-guidelines for vaginal birth after previous caesarean birth. J Obstet Gynaecol Can 2018; 40 (03) e195-e207
- 5 Royal College of Obstetricians and Gynaecologists. Birth after Previous Caesarean Birth. London: RCOG; 2015
- 6 American College of Obstetricians and Gynecologists. ACOG Practice bulletin no. 115: Vaginal birth after previous cesarean delivery. Obstet Gynecol 2010; 116 (2 Pt 1): 450-463
- 7 American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 205 Summary: Vaginal birth after cesarean delivery. Obstet Gynecol 2019; 133 (02) 393-395
- 8 National Institute for Health and Clinical Excellence. Caesarean Section: Evidence Update March 2013. Manchester, UK: National Institute for Health and Clinical Excellence; 2013
- 9 Cunningham FG, Bangdiwala SI, Brown SS. , et al. NIH consensus development conference draft statement on vaginal birth after cesarean: new insights. NIH Consens State Sci Statements 2010; 27 (03) 1-42
- 10 Barber EL, Lundsberg LS, Belanger K, Pettker CM, Funai EF, Illuzzi JL. Indications contributing to the increasing cesarean delivery rate. Obstet Gynecol 2011; 118 (01) 29-38
- 11 Landon MB, Hauth JC, Leveno KJ. , et al; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. N Engl J Med 2004; 351 (25) 2581-2589
- 12 Landon MB, Spong CY, Thom E. , et al; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Risk of uterine rupture with a trial of labor in women with multiple and single prior cesarean delivery. Obstet Gynecol 2006; 108 (01) 12-20
- 13 Miller DA, Diaz FG, Paul RH. Vaginal birth after cesarean: a 10-year experience. Obstet Gynecol 1994; 84 (02) 255-258
- 14 Caughey AB, Shipp TD, Repke JT, Zelop CM, Cohen A, Lieberman E. Rate of uterine rupture during a trial of labor in women with one or two prior cesarean deliveries. Am J Obstet Gynecol 1999; 181 (04) 872-876
- 15 Spaans WA, van der Vliet LME, Röell-Schorer EAM, Bleker OP, van Roosmalen J. Trial of labour after two or three previous caesarean sections. Eur J Obstet Gynecol Reprod Biol 2003; 110 (01) 16-19
- 16 Macones GA, Cahill A, Pare E. , et al. Obstetric outcomes in women with two prior cesarean deliveries: Is vaginal birth after cesarean delivery a viable option?. Am J Obstet Gynecol 2005; 192 (04) 1223-1228
- 17 Wingert A, Hartling L, Sebastianski M. , et al. Clinical interventions that influence vaginal birth after cesarean delivery rates: systematic review & meta-analysis. BMC Pregnancy Childbirth 2019; 19 (01) 529
- 18 Gilbert SA, Grobman WA, Landon MB. , et al. Lifetime cost-effectiveness of trial of labor after cesarean in the United States. Value Heal 2013; 16 (06) 953-964
- 19 Crowther CA, Dodd JM, Hiller JE, Haslam RR, Robinson JS. Birth After Caesarean Study Group. Planned vaginal birth or elective repeat caesarean: patient preference restricted cohort with nested randomised trial. PLoS Med 2012; 9 (03) e1001192
- 20 Wilmink FA, Hukkelhoven CWPM, Lunshof S, Mol BWJ, van der Post JAM, Papatsonis DNM. Neonatal outcome following elective cesarean section beyond 37 weeks of gestation: a 7-year retrospective analysis of a national registry. Am J Obstet Gynecol 2010; 202 (03) 250.e1-250.e8
- 21 Guise JM, Berlin M, McDonagh M, Osterweil P, Chan B, Helfand M. Safety of vaginal birth after cesarean: a systematic review. Obstet Gynecol 2004; 103 (03) 420-429
- 22 Mozurkewich EL, Hutton EK. Elective repeat cesarean delivery versus trial of labor: a meta-analysis of the literature from 1989 to 1999. Am J Obstet Gynecol 2000; 183 (05) 1187-1197
- 23 Guise JM, Eden K, Emeis C. , et al. Vaginal birth after cesarean: new insights. Evid Rep Technol Assess 2010; 191 (191) 1-397
- 24 Tahseen S, Griffiths M. Vaginal birth after two caesarean sections (VBAC-2) - A systematic review with meta-analysis of success rate and adverse outcomes of VBAC-2 versus VBAC-1 and repeat (third) caesarean sections. BJOG An Int J Obstet Gynaecol 2010; 117 (01) 5-19
- 25 Triebwasser JE, Kamdar NS, Langen ES. , et al. Hospital contribution to variation in rates of vaginal birth after cesarean. J Perinatol 2019; 39 (07) 904-910
- 26 Modzelewski J, Jakubiak-Proc M, Materny A, Sotniczuk M, Kajdy A, Rabijewski M. Safety and success rate of vaginal birth after two cesarean sections: retrospective cohort study. Ginekol Pol 2019; 90 (08) 444-451
- 27 Cahill AG, Stamilio DM, Odibo AO. , et al. Is vaginal birth after cesarean (VBAC) or elective repeat cesarean safer in women with a prior vaginal delivery?. Am J Obstet Gynecol 2006; 195 (04) 1143-1147
- 28 Kalok A, Zabil SA, Jamil MA. , et al. Antenatal scoring system in predicting the success of planned vaginal birth following one previous caesarean section. J Obstet Gynaecol 2018; 38 (03) 1-5
- 29 Tita ATN, Landon MB, Spong CY. , et al; Eunice Kennedy Shriver NICHD Maternal-Fetal Medicine Units Network. Timing of elective repeat cesarean delivery at term and neonatal outcomes. N Engl J Med 2009; 360 (02) 111-120
- 30 Ferreira I, Gbatu PT, Boreham CA. Gestational age and cardiorespiratory fitness in individuals born at term: a life course study. J Am Heart Assoc 2017; 6 (10) e006467