Comparing Spontaneous Labor Outcomes in TOLACs and Nulliparas [25P]

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Abstract

INTRODUCTION:

To compare spontaneous labor outcomes in women undergoing TOLAC to nulliparas to aid in counseling and management.

METHODS:

A 4-year retrospective cohort at two tertiary care centers. We included women at term in spontaneous labor with vertex singletons and no more than one prior cesarean section. TOLACs were matched 1:1 with contemporaneous nulliparas. Maternal demographics and maternal and neonatal complications were abstracted from the medical record.

RESULTS:

Our cohort included 1,212 women: 606 TOLACs and 606 nulliparas. Women undergoing TOLAC were older (31.5 vs. 29.3 years; P<.01), heavier (BMI 26.1 vs. 24.7; P<.01), more likely to be black (16.9% vs. 11.8%; P<.01) or Hispanic (17.4% vs. 15.3%; P≤.01) and to have diabetes (4.1% vs. 1.3%; P<.01) or hypertension (6.4% vs. 3.3%; P≤.01). Women undergoing TOLAC were more likely to undergo cesarean delivery (CD) (25.7% vs. 14.7%; P<.001). There was no difference in emergent CD or maternal or neonatal complications, with the exception of severe hemorrhage (1.5% vs. 0.2%; P=.02). In our cohort, the predicted success score from the MFMU-VBAC calculator ranged from 22.0% to 84.7% with 20.6% having a score less than 50%. We considered women to be “good TOLAC candidates” if their score was 70% or greater (29.7% of our sample). Comparing good TOLAC candidates to all nulliparas, there was no difference in CD rate (16.7% vs. 14.7%; P=.51) nor any difference in maternal or neonatal complications.

CONCLUSION:

Labor outcomes were similar in women presenting in labor undergoing TOLAC and nulliparas. “Good TOLAC candidates” were no more likely to experience a CD or complication.

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