Factors Associated with Failed Trial of Labor after Cesarean, among Women with Twin Gestation-A Multicenter Retrospective Cohort Study
Objective: Twin trial of labor after a cesarean section (TOLAC) is associated with a lower success rate of vaginal delivery than singleton TOLAC, and a higher rate of adverse outcomes in comparison to an elective repeat cesarean delivery. This study aims to investigate the factors associated with fa...
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Published in | Journal of clinical medicine Vol. 11; no. 15; p. 4256 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
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22.07.2022
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Abstract | Objective: Twin trial of labor after a cesarean section (TOLAC) is associated with a lower success rate of vaginal delivery than singleton TOLAC, and a higher rate of adverse outcomes in comparison to an elective repeat cesarean delivery. This study aims to investigate the factors associated with failed TOLAC, among women with twin gestation. Study design: A multicenter retrospective cohort study was undertaken. All women with twin pregnancies attempting a trial of labor after a previous cesarean in two university-affiliated obstetrical centers, between 2005 and 2021 were included. The study population included women with a twin gestation where twin A presented in the vertex position, a single previous low segment transverse section, and those who were eligible for a vaginal delivery. Labor, maternal, and neonatal characteristics were compared. A univariate analysis was undertaken, followed by multivariate analysis (aORs; [95% CI]). Results: A total of 160 women attempting a twin TOLAC were included. Vaginal birth after cesarean was achieved in 86.3% of these cases. Assisted reproductive technology (ART), the lack of oxytocin use for augmentation during labor, the lack of epidural analgesia, and preterm birth before 34, 32, and 28 gestational weeks were all found to be associated with failed TOLAC. In the multivariate analysis, cervical dilation on admission (aOR 0.6 [0.40−0.82], p < 0.01), no use of oxytocin (aOR 5.2 [1.36−19.73], p = 0.02), gestational age at delivery (aOR 0.8 [0.65−1.00], p = 0.047) and lack of epidural analgesia (aOR 4.5 [1.01−20.16], p = 0.049), were all found to be significantly associated with failed TOLAC. Conclusion: In the investigated population of women with twins undergoing TOLAC, the use of epidural analgesia, the use of oxytocin and increased cervical dilation to the delivery room are associated with a higher rate of vaginal delivery, and may reduce the risk of repeat cesarean delivery. |
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AbstractList | Objective: Twin trial of labor after a cesarean section (TOLAC) is associated with a lower success rate of vaginal delivery than singleton TOLAC, and a higher rate of adverse outcomes in comparison to an elective repeat cesarean delivery. This study aims to investigate the factors associated with failed TOLAC, among women with twin gestation. Study design: A multicenter retrospective cohort study was undertaken. All women with twin pregnancies attempting a trial of labor after a previous cesarean in two university-affiliated obstetrical centers, between 2005 and 2021 were included. The study population included women with a twin gestation where twin A presented in the vertex position, a single previous low segment transverse section, and those who were eligible for a vaginal delivery. Labor, maternal, and neonatal characteristics were compared. A univariate analysis was undertaken, followed by multivariate analysis (aORs; [95% CI]). Results: A total of 160 women attempting a twin TOLAC were included. Vaginal birth after cesarean was achieved in 86.3% of these cases. Assisted reproductive technology (ART), the lack of oxytocin use for augmentation during labor, the lack of epidural analgesia, and preterm birth before 34, 32, and 28 gestational weeks were all found to be associated with failed TOLAC. In the multivariate analysis, cervical dilation on admission (aOR 0.6 [0.40−0.82], p < 0.01), no use of oxytocin (aOR 5.2 [1.36−19.73], p = 0.02), gestational age at delivery (aOR 0.8 [0.65−1.00], p = 0.047) and lack of epidural analgesia (aOR 4.5 [1.01−20.16], p = 0.049), were all found to be significantly associated with failed TOLAC. Conclusion: In the investigated population of women with twins undergoing TOLAC, the use of epidural analgesia, the use of oxytocin and increased cervical dilation to the delivery room are associated with a higher rate of vaginal delivery, and may reduce the risk of repeat cesarean delivery. Objective: Twin trial of labor after a cesarean section (TOLAC) is associated with a lower success rate of vaginal delivery than singleton TOLAC, and a higher rate of adverse outcomes in comparison to an elective repeat cesarean delivery. This study aims to investigate the factors associated with failed TOLAC, among women with twin gestation. Study design: A multicenter retrospective cohort study was undertaken. All women with twin pregnancies attempting a trial of labor after a previous cesarean in two university-affiliated obstetrical centers, between 2005 and 2021 were included. The study population included women with a twin gestation where twin A presented in the vertex position, a single previous low segment transverse section, and those who were eligible for a vaginal delivery. Labor, maternal, and neonatal characteristics were compared. A univariate analysis was undertaken, followed by multivariate analysis (aORs; [95% CI]). Results: A total of 160 women attempting a twin TOLAC were included. Vaginal birth after cesarean was achieved in 86.3% of these cases. Assisted reproductive technology (ART), the lack of oxytocin use for augmentation during labor, the lack of epidural analgesia, and preterm birth before 34, 32, and 28 gestational weeks were all found to be associated with failed TOLAC. In the multivariate analysis, cervical dilation on admission (aOR 0.6 [0.40–0.82], p < 0.01), no use of oxytocin (aOR 5.2 [1.36–19.73], p = 0.02), gestational age at delivery (aOR 0.8 [0.65–1.00], p = 0.047) and lack of epidural analgesia (aOR 4.5 [1.01–20.16], p = 0.049), were all found to be significantly associated with failed TOLAC. Conclusion: In the investigated population of women with twins undergoing TOLAC, the use of epidural analgesia, the use of oxytocin and increased cervical dilation to the delivery room are associated with a higher rate of vaginal delivery, and may reduce the risk of repeat cesarean delivery. Objective: Twin trial of labor after a cesarean section (TOLAC) is associated with a lower success rate of vaginal delivery than singleton TOLAC, and a higher rate of adverse outcomes in comparison to an elective repeat cesarean delivery. This study aims to investigate the factors associated with failed TOLAC, among women with twin gestation. Study design: A multicenter retrospective cohort study was undertaken. All women with twin pregnancies attempting a trial of labor after a previous cesarean in two university-affiliated obstetrical centers, between 2005 and 2021 were included. The study population included women with a twin gestation where twin A presented in the vertex position, a single previous low segment transverse section, and those who were eligible for a vaginal delivery. Labor, maternal, and neonatal characteristics were compared. A univariate analysis was undertaken, followed by multivariate analysis (aORs; [95% CI]). Results: A total of 160 women attempting a twin TOLAC were included. Vaginal birth after cesarean was achieved in 86.3% of these cases. Assisted reproductive technology (ART), the lack of oxytocin use for augmentation during labor, the lack of epidural analgesia, and preterm birth before 34, 32, and 28 gestational weeks were all found to be associated with failed TOLAC. In the multivariate analysis, cervical dilation on admission (aOR 0.6 [0.40–0.82], p < 0.01), no use of oxytocin (aOR 5.2 [1.36–19.73], p = 0.02), gestational age at delivery (aOR 0.8 [0.65–1.00], p = 0.047) and lack of epidural analgesia (aOR 4.5 [1.01–20.16], p = 0.049), were all found to be significantly associated with failed TOLAC. Conclusion: In the investigated population of women with twins undergoing TOLAC, the use of epidural analgesia, the use of oxytocin and increased cervical dilation to the delivery room are associated with a higher rate of vaginal delivery, and may reduce the risk of repeat cesarean delivery. |
Author | Joseph, Jordanna Martinotti, Tal Grisaru-Granovsky, Sorina Rottenstreich, Misgav Sela, Hen Y Peled, Tzuria |
AuthorAffiliation | 2 Department of Nursing, Jerusalem College of Technology, Jerusalem 91031, Israel 1 Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91031, Israel; tzuria10@gmail.com (T.P.); hysela@szmc.org.il (H.Y.S.); jordannajoseph@hotmail.com (J.J.); tal.martinotti@gmail.com (T.M.); sorina@szmc.org.il (S.G.-G.) |
AuthorAffiliation_xml | – name: 1 Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91031, Israel; tzuria10@gmail.com (T.P.); hysela@szmc.org.il (H.Y.S.); jordannajoseph@hotmail.com (J.J.); tal.martinotti@gmail.com (T.M.); sorina@szmc.org.il (S.G.-G.) – name: 2 Department of Nursing, Jerusalem College of Technology, Jerusalem 91031, Israel |
Author_xml | – sequence: 1 givenname: Tzuria surname: Peled fullname: Peled, Tzuria organization: Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91031, Israel – sequence: 2 givenname: Hen Y orcidid: 0000-0002-9859-469X surname: Sela fullname: Sela, Hen Y organization: Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91031, Israel – sequence: 3 givenname: Jordanna surname: Joseph fullname: Joseph, Jordanna organization: Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91031, Israel – sequence: 4 givenname: Tal surname: Martinotti fullname: Martinotti, Tal organization: Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91031, Israel – sequence: 5 givenname: Sorina surname: Grisaru-Granovsky fullname: Grisaru-Granovsky, Sorina organization: Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91031, Israel – sequence: 6 givenname: Misgav orcidid: 0000-0003-4875-1455 surname: Rottenstreich fullname: Rottenstreich, Misgav organization: Department of Nursing, Jerusalem College of Technology, Jerusalem 91031, Israel |
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Cites_doi | 10.1056/NEJMoa1214939 10.1155/2021/6693142 10.1016/j.ajog.2007.03.013 10.1007/s00404-021-06062-2 10.1080/jmf.10.3.171.174 10.1007/s00404-016-4151-5 10.1016/j.ajog.2018.11.125 10.1111/j.1523-536X.2010.00405.x 10.1016/j.ajog.2006.06.036 10.3109/14767050903156700 10.1016/j.ajog.2005.06.038 10.1097/AOG.0000000000003078 10.1097/AOG.0b013e318163c435 10.1016/j.ajogmf.2022.100640 10.1111/birt.12434 10.1016/j.fertnstert.2013.09.026 10.1111/jog.14154 10.1016/S0140-6736(18)31930-5 |
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Snippet | Objective: Twin trial of labor after a cesarean section (TOLAC) is associated with a lower success rate of vaginal delivery than singleton TOLAC, and a higher... |
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SubjectTerms | Apgar score Birth weight Certified nurse-midwives cesarean delivery Clinical medicine Cohort analysis delivery Epidural Gestational age Hemorrhage Hospitalization Hysterectomy Midwifery Multiple births Normal distribution Obstetrics Respiratory distress syndrome Statistical analysis Success trial of labor after cesarean twin Twins Vagina Ventilators |
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Title | Factors Associated with Failed Trial of Labor after Cesarean, among Women with Twin Gestation-A Multicenter Retrospective Cohort Study |
URI | https://www.ncbi.nlm.nih.gov/pubmed/35893349 https://www.proquest.com/docview/2700670583/abstract/ https://search.proquest.com/docview/2695293060 https://pubmed.ncbi.nlm.nih.gov/PMC9332010 https://doaj.org/article/0f4dc44e11b04e0e8bec352547d7ed3a |
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