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Trial of labor after cesarean in women with hypertensive disorders and no prior vaginal delivery

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Key message

Trial of labor among women who never delivered vaginally with hypertensive disorder is associated with nearly half the success rate of the general population.

Purpose

To study the trial of labor after cesarean (TOLAC) among women with hypertensive disorders and no prior vaginal delivery.

Methods

A retrospective cohort study was conducted including women with no prior vaginal delivery undergoing TOLAC during 2010–2020. Women with hypertensive disorder were compared to those without.

Results

A total of 54/2,144 (2.5%) TOLACs had a hypertensive disorder: 32 (59%) had gestational hypertension, 16 (30%) had chronic hypertension and 6 (11%) had preeclampsia. Women with hypertensive disorders had higher BMI and higher proportion of diabetic disorders. TOLAC success rate was lower among hypertensive mothers: 32 (59%) vs. 1,605 (76.8%), p=0.003 odds ratio (OR), 95% confidence interval (CI) 0.44 (0.25–0.76). The rate of uterine rupture was 23/2,144 (1.1%). In a multivariable logistic regression analysis, hypertensive disorder was independently negatively associated with TOLAC success, adjusted OR (95% CI) 0.47 (0.26–0.85). Other factors negatively independently associated with TOLAC failure were maternal age, predelivery body mass index, dystocia at primary CD, gestational age at TOLAC, induction of labor and birth weight. Epidural was independently positively associated with TOLAC success, adjusted OR (95% CI) 1.54 (1.18–1.99).

Conclusion

TOLAC in hypertensive women with no prior vaginal delivery is safe. Success rate is impaired in comparison to non-hypertensive women.

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Abbreviations

TOLAC:

Trial of labor after cesarean

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Acknowledgements

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Funding

No external funding was used in the conduct of this study.

Author information

Authors and Affiliations

  1. The Department of Gynecologic Oncology, Hadassah Medical Center, Jerusalem, Israel

    Gabriel Levin

  2. Faculty of Medicine, Hebrew University, Jerusalem, Israel

    Gabriel Levin

  3. Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Hadassah-Hebrew University Medical Center, POB 12000, 91120, Ramat-GanJerusalem, Israel

    Gabriel Levin, Abraham Tsur & Raanan Meyer

  4. Faculty of Medicine, Tel-Aviv-Hebrew University, Tel-Aviv, Israel

    Abraham Tsur, Lee Tenenbaum, Nizan Mor, Michal Zamir & Raanan Meyer

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  1. Gabriel Levin
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  2. Abraham Tsur
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  4. Nizan Mor
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  5. Michal Zamir
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  6. Raanan Meyer
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Contributions

RM and GL: conceptualization, formal analysis, investigation and methodology, writing—original draft, and writing—review and editing. AT, LT, NM and MZ: data collection. All authors contributed to the manuscript. RM: project development, data collection and management, analysis and interpretation of data, manuscript writing, approval of the version to be published. AT: project development, data collection and management, analysis and interpretation of data, approval of the version to be published. LT: project development, data collection and management, approval of the version to be published. NM: project development, data collection and management, approval of the version to be published. MZ: project development, data collection and management, approval of the version to be published. GL: project development, analysis and interpretation of data, manuscript writing, approval of the version to be published.

Corresponding author

Correspondence to Gabriel Levin.

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Conflict of interests

The authors declare that they have no conflict of interest.

Ethical standards

For this type of study, formal consent is not required and was waived by the institutional review board approval. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Ethical approval

The study protocol was approved by the Sheba Medical Center review board (7145–20-SMC, 30/09/2020).

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Levin, G., Tsur, A., Tenenbaum, L. et al. Trial of labor after cesarean in women with hypertensive disorders and no prior vaginal delivery. Arch Gynecol Obstet 307, 771–777 (2023). https://doi.org/10.1007/s00404-022-06601-5

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  • DOI: https://doi.org/10.1007/s00404-022-06601-5

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