Trial of labor following cesarean among patients with polyhydramnios: a multicenter retrospective study

IF 2.1 3区 医学 Q2 OBSTETRICS & GYNECOLOGY Archives of Gynecology and Obstetrics Pub Date : 2024-09-21 DOI:10.1007/s00404-024-07742-5
Ari Weiss, Tzuria Peled, Reut Rotem, Hen Y. Sela, Sorina Grisaru-Granovsky, Misgav Rottenstreich
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Abstract

Purpose

This study aimed to assess maternal and neonatal outcomes in patients with polyhydramnios attempting trial of labor after cesarean (TOLAC) compared to those undergoing planned repeat cesarean delivery (PRCD).

Methods

A multi-center retrospective cohort study was conducted and included women with term singleton viable pregnancies following a single low-segment transverse cesarean delivery (CD) with a polyhydramnios diagnosis (maximal vertical pocket > 8 cm and/or Amniotic Fluid Index > 24 cm) within 14 days before birth who delivered between the years 2017 and 2021. Maternal and neonatal outcomes were compared between those attempting TOLAC and those opting for PRCD. The primary outcome was composite adverse maternal. Univariate analysis was followed by multivariate analysis to control for potential confounders.

Results

Out of 358 included births with a previous CD, 208 (58.1%) attempted TOLAC, while 150 had PRCD (41.9%). The successful vaginal birth after cesarean (VBAC) rate was 82.2%, and no cases of uterine rupture, hysterectomy, or maternal intensive care unit admission occurred in either group. After controlling for potential confounders, no independent association between TOLAC and composite adverse maternal (adjusted odds ratio [aOR] 0.62, 95% confidence interval [CI] 0.32–1.20, p = 0.16) and neonatal (aOR 0.89, 95% CI 0.51–1.53, p = 0.67) adverse outcomes was demonstrated.

Conclusion

In patients with a term diagnosed polyhydramnios, TOLAC appears to be a reasonable alternative associated with favorable outcomes. Larger prospective studies are needed to refine management strategies and enhance maternal and neonatal outcomes in this context.

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多胎妊娠患者剖宫产后试产:一项多中心回顾性研究。
目的:本研究旨在评估剖宫产术后试产(TOLAC)与计划再次剖宫产(PRCD)的多胎妊娠患者的产妇和新生儿结局:该研究是一项多中心回顾性队列研究,纳入了2017年至2021年期间分娩的、单次低段横切口剖宫产(CD)并在产前14天内诊断出多羊水(最大垂直袋>8厘米和/或羊水指数>24厘米)的足月单胎存活妊娠妇女。对尝试 TOLAC 和选择 PRCD 的产妇和新生儿结局进行了比较。主要结果是产妇综合不良反应。单变量分析后进行多变量分析,以控制潜在的混杂因素:结果:在358名既往有子宫内膜异位症的新生儿中,208名(58.1%)尝试了TOLAC,150名(41.9%)进行了PRCD。剖宫产后经阴道分娩(VBAC)的成功率为82.2%,两组产妇均未发生子宫破裂、子宫切除或入住重症监护室。在控制了潜在的混杂因素后,TOLAC与产妇(调整赔率[aOR]0.62,95%置信区间[CI]0.32-1.20,P = 0.16)和新生儿(aOR 0.89,95%置信区间[CI]0.51-1.53,P = 0.67)综合不良结局之间没有独立的关联:结论:对于确诊为多羊水症的产妇,TOLAC似乎是一种合理的选择,并能带来良好的结果。在这种情况下,需要进行更大规模的前瞻性研究,以完善管理策略,提高孕产妇和新生儿的预后。
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来源期刊
CiteScore
4.70
自引率
15.40%
发文量
493
审稿时长
1 months
期刊介绍: Founded in 1870 as "Archiv für Gynaekologie", Archives of Gynecology and Obstetrics has a long and outstanding tradition. Since 1922 the journal has been the Organ of the Deutsche Gesellschaft für Gynäkologie und Geburtshilfe. "The Archives of Gynecology and Obstetrics" is circulated in over 40 countries world wide and is indexed in "PubMed/Medline" and "Science Citation Index Expanded/Journal Citation Report". The journal publishes invited and submitted reviews; peer-reviewed original articles about clinical topics and basic research as well as news and views and guidelines and position statements from all sub-specialties in gynecology and obstetrics.
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