Trial of labor after cesarean in twin gestation with no prior vaginal delivery – evidence from largest cohort reported

Autor: Gabriel Levin, Simcha Yagel, Anat Schwartz, Ariel Many, Joshua I. Rosenbloom, Yoav Yinon, Raanan Meyer
Rok vydání: 2022
Předmět:
Zdroj: International Journal of Gynecology & Obstetrics. 159:229-236
ISSN: 1879-3479
0020-7292
DOI: 10.1002/ijgo.14090
Popis: To investigate trial of labor after cesarean (TOLAC) success rates in twin gestations with no prior vaginal delivery.A retrospective study of women with twin gestations who underwent a TOLAC and had no prior vaginal delivery during 2011-2020. TOLAC success and failure groups were compared.Of 675 twin gestations with a history of cesarean delivery and no prior vaginal delivery, 83 (12.3%) elected to undergo a TOLAC and 26 (31.3%) succeeded. Two (7.7%) women delivered by cesarean for the second twin after vaginal delivery of the first twin. Epidural analgesia was positively associated with TOLAC success (odds ratio [OR] 4.31, 95% confidence interval [CI] 1.56-11.94, P = 0.004). Uterine rupture occurred in two patients (3.5%) of the TOLAC failure group. The proportion of cases with low Apgar score (7) at 5 min was higher in the TOLAC success group (4 [15.4%] versus 1 [1.8%]; OR 10.1, 95% CI 1.07-96.22, P = 0.032) and the neonatal composite adverse outcome rate was lower in this group (OR 0.22, 95% CI 0.07-0.69, P = 0.009).TOLAC in women with twins with no prior vaginal delivery is associated with a low success rate. No independent predictors of successful TOLAC were identified.
Databáze: OpenAIRE
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