Predicting attempted vaginal labor after cesarean section

• Yulia D. Vuchenovich
• Arsen A. Ziyadinov
• Vladislavа A. Novikovа
• Victor E. Radzinsky

Abstract

The aim of this study - to create a model for predicting the outcome of trial of Labor after cesarean (TOLAC) based on anamnestic, general clinical, antenatal and intranatal predictors.

Material and methods. In the period 2013 (January) - 2019 (July), a prospective cohort study was conducted in maternity hospitals No. 68 and No. 29 in Moscow, in accordance with clinical protocols. 190 patients with TOLAC included: 100 - vaginal birth after cesarean (VBAC), 90 had an intrapartum CS.

Results. Identified clinical-anamnestic, antenatal and intranatal predictors of the TOLAC. A history of two CSs was not associated with intranatal CS (OR=0.2, 95% CI 0.09-0.44). Childbirth history does not significantly increase the success of TOLAC (OR=1.35, 95% CI 0.72-2.53) Differentiated antenatal and intranatal predictors of TOLAC. Demonstrated the relationship between anomalies of labor, threatening uterine rupture, intranatal distress of the fetus and failure of TOLAC.

Conclusion. Success of TOLAC depends on the quality of the regeneration of the myometrium. The exact biological maturity of the cervix, myometrial tone disorder before labor with a burdened reproductive history, the presence of 2 or more markers of undifferentiated connective tissue dysplasia are associated with an unsuccessful TOLAC. Treatment-resistant anomalies of labor, with a wealthy scar, reflect persistent acquired dysfunction in the operated uterus. The modern possibilities of the routine use of analgesia, delivery, tocolysis require timely diagnosis of uterine scar failure, which is quite feasible with individual management of labor, the resource of modern obstetric hospitals.

Keywords:trial of labor after cesarean (TOLAC), vaginal birth after cesarean (VBAC), operated uterus, labor abnormalities, uterine scar after cesarean section, uterine rupture, fetal distress

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