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Trial of labor after cesarean in twin gestation with no prior vaginal delivery – evidence from largest cohort reported
Author(s) -
Levin Gabriel,
Yagel Simcha,
Schwartz Anat,
Many Ariel,
Rosenbloom Joshua I.,
Yi Yoav,
Meyer Raanan
Publication year - 2022
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1002/ijgo.14090
Subject(s) - medicine , vaginal delivery , gestation , odds ratio , obstetrics , confidence interval , retrospective cohort study , gynecology , uterine rupture , pregnancy , surgery , uterus , genetics , biology
Abstract Objective To investigate trial of labor after cesarean (TOLAC) success rates in twin gestations with no prior vaginal delivery. Methods A retrospective study of women with twin gestations who underwent a TOLAC and had no prior vaginal delivery during 2011–2020. TOLAC success and failure groups were compared. Results Of 675 twin gestations with a history of cesarean delivery and no prior vaginal delivery, 83 (12.3%) elected to undergo a TOLAC and 26 (31.3%) succeeded. Two (7.7%) women delivered by cesarean for the second twin after vaginal delivery of the first twin. Epidural analgesia was positively associated with TOLAC success (odds ratio [OR] 4.31, 95% confidence interval [CI] 1.56–11.94, P = 0.004). Uterine rupture occurred in two patients (3.5%) of the TOLAC failure group. The proportion of cases with low Apgar score (<7) at 5 min was higher in the TOLAC success group (4 [15.4%] versus 1 [1.8%]; OR 10.1, 95% CI 1.07–96.22, P = 0.032) and the neonatal composite adverse outcome rate was lower in this group (OR 0.22, 95% CI 0.07–0.69, P = 0.009). Conclusion TOLAC in women with twins with no prior vaginal delivery is associated with a low success rate. No independent predictors of successful TOLAC were identified.