The association between trial of labor after cesarean in obese patients and adverse maternal outcomes

Purpose We hypothesized that among obese patients with a history of cesarean birth, a TOLAC is associated with decreased composite maternal adverse outcomes (CMAO) compared to planned repeat low transverse cesarean section (RLTCS). Methods In this population-based cross-sectional study using the Nat...

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Bibliographic Details
Published in:Archives of gynecology and obstetrics 2024-06, Vol.309 (6), p.2421-2426
Main Authors: Jude, Gabrielle, Fain, Audra, Raker, Christina, Rubenstein, Shayna, Bicocca, Matthew, Wagner, Stephen, Gupta, Megha
Format: Article
Language:English
Subjects:
Adult
Births
Cesarean Section - statistics & numerical data
Cesarean Section, Repeat - statistics & numerical data
Cross-Sectional Studies
Endocrinology
Female
Gynecology
Human Genetics
Humans
Maternal-Fetal Medicine
Medicine
Medicine & Public Health
Obesity - complications
Obstetrics/Perinatology/Midwifery
Pregnancy
Pregnancy Complications - epidemiology
Pregnancy Outcome - epidemiology
Trial of Labor
Uterine Rupture - epidemiology
Uterine Rupture - etiology
Vaginal Birth after Cesarean - statistics & numerical data
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Summary:Purpose We hypothesized that among obese patients with a history of cesarean birth, a TOLAC is associated with decreased composite maternal adverse outcomes (CMAO) compared to planned repeat low transverse cesarean section (RLTCS). Methods In this population-based cross-sectional study using the National Birth Certificate database from 2016 to 2020, we compared obese patients who attempted TOLAC at term (≥ 37 weeks estimated gestational age) to planned RLTCS. The primary outcome was a CMAO, defined as delivery complications, including intensive care unit (ICU) admission, uterine rupture, unplanned hysterectomy, or maternal blood transfusion. Results Overall, 794,278 patients met inclusion criteria for the study; 126,809 underwent a TOLAC, and 667,469 had a planned RLTCS. The overall CMAO was significantly higher for patients undergoing TOLAC (9.0 per 1000 live births) compared to RLTCS (5.3 per 1000 live births; aRR 1.64, 95% CI 1.53–1.75). Conclusion This data demonstrate that in obese patients with prior cesarean birth, a trial of labor is associated with increased maternal morbidity when compared to a planned repeat cesarean birth.
ISSN:1432-0711
0932-0067
1432-0711
DOI:10.1007/s00404-023-07113-6