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Exclusion criteria were as follows: (1) pregnancy ending up in a nonviable stage or earlier than 26 weeks of gestation, (2) incomplete medical data records, and (3) fetal macrosomia. The inclusion criteria were as follows: (1) singleton pregnancy, (2) low-transverse uterine incision, (3) no history of other uterine incision such as myomectomy, and (4) no obstetric risk or serious underlying disease unsuitable for vaginal delivery. The database of Maternal-Fetal Medicine (MFM) unit was assessed to identify the consecutive records of women with a history of previous cesarean section between January 2001 and December 2015, and their medical records were reviewed. Materials and MethodsĪ retrospective cohort study was conducted on consecutive singleton pregnancies with a previous single low-transverse cesarean section planned for TOLAC at a tertiary teaching hospital with ethical approval by the institutional review board. Therefore, we conducted this study to determine the effectiveness of trials of labor after cesarean section (TOLAC) and the factors associated with its success. To date, we still have that policy, but its effectiveness in our real practice has never been evaluated. TOLAC has been practiced individually in our center for decades, but the formal policy of TOLAC was first implemented in the year 2000.
#Tolac vs vbag trial#
According to the American College of Obstetricians and Gynecologists (ACOG), most women with one previous cesarean delivery and a low-transverse incision are candidates of TOLAC and should be counseled about TOLAC and offered a trial of labor. It has long been accepted that TOLAC is a safe and acceptable option for women with previous cesarean section. Overall, morbidity and mortality rates secondary to TOLAC are less than those of repeated cesarean sections. However, TOLAC has a minimal risk of uterine rupture with a rate of 0.2–0.8%, but such a risk can be prevented by close observation and adhering to the standard guideline. Recently, with the dramatic increase in the rate of cesarean deliveries worldwide, several attempts have been made to reduce this rate, including trial of labor after cesarean delivery (TOLAC).
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Women undergoing cesarean section have a higher morbidity and mortality rate than those having vaginal birth, such as massive postpartum hemorrhage, need for blood transfusion, anesthesia-associated complications, surgical risks (intestinal obstruction, wound dehiscence, wound scars, infection, etc.), and obstetric complications in subsequent pregnancies.
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The audit system is the only potential factor that could be strengthened to improve the success rate. The simple audit system had the greatest impact on the success rate of TOLAC, instead of the less powerful obstetrical factors as reported in previous reports. Strikingly, the strongest predictor of a successful TOLAC was the audit system with OR of 6.4 (95%CI: 3.9-10.44), followed by a history of vaginal birth in previous pregnancies (OR: 3.2 95%CI: 1.87-5.36). The independent factors associated with the success rate included the audit system, prior vaginal birth, low maternal BMI, and lower birth weight or gestational age, whereas induction of labor and recurring indications in previous pregnancy significantly increased the risk of having a failed TOLAC. Among them, 355 (60%) had a successful vaginal birth and 237 (40%) had a failed TOLAC. During the study period, 2,493 women were eligible for TOLAC and 704 of them were scheduled for TOLAC, but finally 592 underwent TOLAC. A simple audit system used in the first two years was also taken into account in the analysis as a potential factor for success. The potential risk factors of a successful TOLAC were compared with those associated with a failed TOLAC. A retrospective cohort study was conducted on consecutive singleton pregnancies with a previous single low-transverse cesarean section planned for TOLAC at a tertiary teaching hospital. To determine the effectiveness of trial of labor after cesarean section (TOLAC) and the factors associated with a successful TOLAC.