Abstract
Background: The rate of cesarean section (CS) is increasing worldwide, despite recommendations of the World Health Organization (WHO). In Europe and in Italy, 25.7% and 31.3% of pregnant women respectively undergo a CS because of both, maternal or neonatal indications. Currently, trial of labor after cesarean delivery (TOLAC) is recommended for the majority of women with one previous CS with a low-transverse incision, with or without a history of previous vaginal delivery. A vaginal birth after cesarean section may decrease the risk of consequences associated with surgery, however, it may be associated with a higher risk of uterine rupture and dehiscence.
Aim: To evaluate maternal and perinatal outcomes associated with a TOLAC and risk factors associated with uterine rupture.
Methods: This was a monocentric retrospective observational study regarding TOLACs performed during 2016 to 2019 among women (24-42 weeks’ gestation) with one or two previous lower uterine segment CSs. The primary outcome was mode of delivery and secondary outcomes were maternal and neonatal outcomes.
Results: The data of a total of 275 patients undergoing TOLAC were included for analysis. Of them, 52.4% had a spontaneous vaginal delivery, 16.7% a vacuum-assisted operative vaginal delivery and the remaining 30.9% underwent a repeat intrapartum cesarean section. In 11 cases of CS, uterine rupture or dehiscence was reported during the surgery with a total incidence of 4.0%. Regarding maternal complications, the most frequent was postpartum hemorrhage. No hysterectomies or maternal deaths occurred. No statistically significant differences in neonatal outcomes were found when comparing women that experienced a uterine rupture and those who did not.
Conclusions: This study confirm a high rate of successful TOLAC in women with a previous CS. Unfavorable cervix emerged to be a statistically significant risk factor associated with uterine rupture and dehiscence.
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