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Trial of labor after cesarean in the low-risk obstetric population: a retrospective nationwide cohort study

Journal of Perinatology volume 36, pages 808–813 (2016)Cite this article

Subjects

Abstract

Objective:

The purpose of this study was to evaluate the risk of adverse maternal outcomes associated with trial of labor (TOL) after cesarean during subsequent pregnancies in the low-risk population.

Study Design:

We conducted a retrospective cohort study using the Nationwide Inpatient Sample and ICD-9 diagnostic and procedure codes from the years 2003 to 2011. A cohort of low-risk pregnant women with a history of previous cesarean delivery were identified and separated into two groups: TOL and no TOL. Logistic regression analysis was used to calculate odds ratios (ORs) comparing adverse maternal outcomes between these two groups.

Results:

Out of 7 290 474 registered deliveries, there were 685 137 low-risk women who met inclusion criteria. Of these women, 144 066 (21.0%) underwent a TOL, with rates remaining steady over the course of our study. The TOL group was at increased risk of overall morbidity (OR 1.74, 95% confidence interval (CI), 1.66–1.79), most notably uterine rupture (OR 22.52, 95% CI, 19.35–26.20, P<0.01). A secondary analysis showed no apparent correlation between TOL and concomitant adverse maternal outcomes in cases of uterine rupture.

Conclusion:

Although these outcomes remain rare, low-risk women undergoing a TOL remain at increased risk of adverse maternal events as compared with those who chose elective repeat cesarean delivery.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, QC, Canada

    S Stattmiller, M Lavecchia & H A Abenhaim

  2. Center for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, QC, Canada

    N Czuzoj-Shulman, A R Spence & H A Abenhaim

Authors
  1. S Stattmiller
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  2. M Lavecchia
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  3. N Czuzoj-Shulman
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  4. A R Spence
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  5. H A Abenhaim
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Corresponding author

Correspondence to H A Abenhaim.

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The authors declare no conflict of interest.

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Supplementary Information accompanies the paper on the Journal of Perinatology website

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Stattmiller, S., Lavecchia, M., Czuzoj-Shulman, N. et al. Trial of labor after cesarean in the low-risk obstetric population: a retrospective nationwide cohort study. J Perinatol 36, 808–813 (2016). https://doi.org/10.1038/jp.2016.36

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  • DOI: https://doi.org/10.1038/jp.2016.36

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