Trial of labor following cesarean among patients with oligohydramnios at term: A multicenter retrospective study

• Published in: International journal of gynecology and obstetrics
• Main Authors: Weiss, Ari, Peled, Tzuria, Rotem, Reut, Sela, Hen Y., Grisaru‐Granovsky, Sorina, Rottenstreich, Misgav
• Format: Journal Article
• Language: English
• Published: United States 16.05.2025
• Subjects: trial of labor after cesarean; oligohydramnios; uterine rupture; planned repeat cesarean delivery; neonatal outcomes; maternal outcomes; amniotic fluid
• ISSN: 0020-7292; 1879-3479; 1879-3479
• DOI: 10.1002/ijgo.70202

The aim of this study was to evaluate the maternal and neonatal outcomes of patients with oligohydramnios attempting a trial of labor after cesarean (TOLAC) versus those who underwent planned repeat cesarean delivery (PRCD). We conducted a multicenter retrospective cohort study of patients with a term singleton pregnancy following a single low-segment transverse cesarean delivery (CD) and a recent diagnosis of oligohydramnios (maximal vertical pocket <2 cm) between 2017 and 2021. Maternal and neonatal outcomes were compared between patients attempting TOLAC and those opting for PRCD. Univariate analysis was conducted, followed by a multivariate analysis. A total of 352 deliveries were included, of which 278 (79%) attempted TOLAC and 74 (21%) attempted PRCD. The successful vaginal delivery rate for patients who attempted TOLAC was 84.5%. The uterine rupture rate was not significantly different between those attempted TOLAC versus PRCD (1.1% vs. 0%, P = 0.371). However, the rate of hypoglycemia (2.2% vs. 8.1%, P = 0.012) and the composite adverse neonatal outcome was higher among patients with PRCD (11.5% vs. 24.3%, P = 0.005). After controlling for potential confounders, we still demonstrated an independent association between reduced rates of composite adverse neonatal outcome and TOLAC (adjusted odds ratio 0.46, 95% CI: 0.23-0.92, P = 0.028). TOLAC for patients with oligohydramnios appears to be a reasonable alternative and is associated with favorable outcomes. Further large and prospective research on this subject may lead to improved management strategies and better maternal and neonatal outcomes.