Operative Vaginal Delivery Is a Safe Option in Women Undergoing a Trial of Labor after Cesarean

• Published in: American journal of perinatology reports Vol. 9; no. 2; pp. e190 - e194
• Main Authors: Krizman, Erin, Grzebielski, Patricia, Antony, Kathleen M., Sampene, Emmanuel, Shanahan, Matthew, Iruretagoyena, J. Igor, Bohrer, Justin
• Format: Journal Article
• Language: English
• Published: 333 Seventh Avenue, New York, NY 10001, USA Thieme Medical Publishers 01.04.2019; Thieme Medical Publishers, Inc
• Subjects: cesarean delivery; forceps delivery; operative vaginal delivery; Original; Original Article; trial of labor after cesarean; vacuum-assisted delivery; vaginal birth; forceps delivery; vacuum-assisted delivery; trial of labor after cesarean; cesarean delivery; operative vaginal delivery; vaginal birth
• ISSN: 2157-6998; 2157-7005
• DOI: 10.1055/s-0039-1692482

Abstract Objective  To compare outcomes of operative intervention in the second stage of labor during trial of labor after cesarean (TOLAC). Study Design  A secondary analysis of the Maternal-Fetal Medicine Units Network cesarean section registry was conducted. Analysis was by first attempted mode of delivery. Results  A total of 1,837 met inclusion criteria. Subjects in the operative vaginal groups (OVDs) were more likely to have a prior vaginal delivery (vacuum 34.2%; forceps 34.3%) than the repeat cesarean delivery (RCD) group (22.6%; p  < 0.0001). Most OVD attempts were successful (forceps 90.4%; vacuum 92.6%). Neonatal morbidity was not different (12.1% forceps vs. 14.6% vacuum; 14.8% RCD). Maternal morbidity was highest among forceps deliveries (32.3 vs. 24.3% vacuum; 22.0% RCD, p  = 0.0001). RCD was associated with surgical injury (2.7 vs. 0.7% forceps; 0% vacuum; p  < 0.0001), endometritis (8.4 vs. 3.2% forceps, 1.2% vacuum; p  < 0.0001), and wound complications (1.9 vs. 0.4% forceps; 0.3% vacuum; p  = 0.006). OVD was associated with anal sphincter laceration (22.7% forceps, 15.5% vacuum; 0% RCD; p  = 0.01). Conclusion  The success rate of OVD is high in TOLAC with similar outcomes to RCD. Maternal composite outcomes were highest with forceps-assisted vaginal deliveries. However, considering overall morbidity, OVD in the second stage of labor in TOLAC is a reasonable, safe option in selected cases.