Study Objective

Data regarding trial of labor after cesarean delivery (TOLAC) among young women are limited. The aim of this study was to assess the TOLAC success rate and its related factors among adolescent women who had never delivered vaginally.

Design

A multicenter retrospective cohort study of all adolescent women aged ≤21 years with a history of 1 previous cesarean delivery, who delivered in 2 tertiary medical centers during 2007-2019. Women were allocated to 2 groups: 1) women who underwent TOLAC, and 2) women who had a repeat cesarean delivery with no trial of labor. Maternal and neonatal outcomes were compared between the two groups. In addition, perinatal outcomes were compared between women with successful and unsuccessful TOLAC.

Results

The study cohort included 167 women who had a previous caesarean delivery; 117 underwent TOLAC and 50 underwent a repeat cesarean delivery with no trial of labor. Neonatal birthweight (median 2937 vs 3170 g, P = .03) and gestational age at delivery (median 38 weeks vs 39, P = .009) were lower in the repeat cesarean group as compared to those undergoing TOLAC. Overall, 97 of 117 participants (83%) had a successful TOLAC. Failed TOLAC was associated low birthweight as compared to successful TOLAC (5 [25%] vs 7 [7%], odds ratio [OR] 4.3, 95% confidence interval [CI] 1.2-15.3, P = .02), and birthweight difference between current and previous deliveries was higher in the failed TOLAC group (median 315 vs 197 g, P = .04). Rates of neonatal Apgar score at 1 minute < 7 and of neonatal intensive care unit admission were higher in the TOLAC failure group (4 [20%] vs 5 [5%], OR 4.6, 95% CI 1.1-19.0, P = .03, and 4 [20%] vs 4 [4%], OR 5.8, 95% CI 1.3-25.6, P = .02), respectively). In a multivariable logistic regression analysis, only low birthweight was independently associated with TOLAC failure (adjusted OR 9.9, 95% CI 2.1-45.4, P = .003). Two cases of uterine rupture occurred in the no trial of labor group, whereas none were encountered in participants undergoing TOLAC.

Conclusions

TOLAC in adolescent women who had never delivered vaginally is associated with a relatively high success rate.

中文翻译：

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青少年剖宫产术后的分娩试验-多中心研究。

研究目标

关于年轻妇女剖宫产后分娩试验的数据有限。这项研究的目的是评估从未阴道分娩的青春期妇女中的TOLAC成功率及其相关因素。

设计

一项多中心回顾性队列研究，对所有≤21岁，曾有过一次剖腹产的历史的≤21岁的青春期妇女进行研究，她们在2007-2019年期间在两个三级医疗中心分娩。将妇女分为2组：1）接受TOLAC治疗的妇女，以及2）重复剖宫产但未进行分娩试验的妇女。比较两组的母婴结局。此外，对成功和失败TOLAC的妇女的围产期结局进行了比较。

结果

该研究队列包括167名曾接受剖腹产的妇女。117例接受了TOLAC，50例接受了再次剖宫产，没有进行任何人工试验。 重复剖宫产组的新生儿出生体重（中位2937 vs 3170 g，P  = .03）和分娩胎龄（中位38周vs 39，P = .009）比接受TOLAC的要低。总体而言，117位参与者中有97位（83％）成功获得了TOLAC。与成功的TOLAC相比，失败的TOLAC与低出生体重相关（5 [25％]对7 [7％]，优势比[OR] 4.3、95％置信区间[CI] 1.2-15.3，P  = .02）和出生体重失败的TOLAC组的当前分娩与先前分娩之间的差异更大（中位数315 vs 197 g，P = .04）。TOLAC衰竭组的新生儿在1分钟<7时的Apgar评分和新生儿重症监护病房的住院率较高（4 [20％]对5 [5％]，或4.6、95％CI 1.1-19.0，P  =。 03和4 [20％]对4 [4％]，或5.8，95％CI 1.3-25.6，P  = .02）。在多变量logistic回归分析中，只有低出生体重与TOLAC失败独立相关（校正OR 9.9，95％CI 2.1-45.4，P  = .003）。在未进行人工分娩的试验中，有2例发生子宫破裂，而接受TOLAC的受试者中未见到子宫破裂。

结论

未曾阴道分娩的青春期妇女中的TOLAC与较高的成功率相关。