Neonatal outcomes in trial of vaginal birth versus repeat caesarean delivery in preterm pregnancies: A prospective cohort study

• Published in: BJOG : an international journal of obstetrics and gynaecology Vol. 129; no. 8; pp. 1319 - 1324
• Main Authors: C. Suresh, Sunitha, Dude, Annie
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-07-2022
• Subjects: Birth; Cesarean section; Childbirth & labor; Cohort analysis; Encephalopathy; Enterocolitis; Fetuses; Gestational age; Hypoxia; Ischemia; Morbidity; Necrotizing enterocolitis; neonatal outcomes; Neonates; Newborn babies; Pregnancy; Premature birth; preterm delivery; Respiratory distress syndrome; Seizures; Sepsis; Statistical analysis; trial of labour after caesarean delivery; Uterus; Vagina; trial of labour after caesarean delivery; neonatal outcomes; preterm delivery
• ISSN: 1470-0328; 1471-0528
• DOI: 10.1111/1471-0528.17056

Objective
To characterise neonatal morbidity following preterm trial of labour (TOL) in comparison with elective repeat caesarean section (eRCS) specifically among patients without a previous vaginal delivery who may have a lower success rate of vaginal birth after caesarean.
Design
This is a secondary analysis of a multicentre prospective database.
Setting/Population
Maternal and Fetal Medicine Unit Cesarean Section Registry.
Population
Singleton pregnancies in women without a previous vaginal delivery who delivered at 24+0 weeks to 36+6 weeks gestation.
Methods
Neonatal outcomes were compared between those with a TOL and those undergoing eRCS. Logistic regression was used to control for confounders, including gestational age at delivery.
Main Outcome Measures
Composite neonatal morbidity.
Results
A total of 1906 patients were included, 985 with TOL and 921 with no TOL. The TOL success rate was 63.1%. The rate of uterine rupture was low, at 0.10% in the TOL group and 0.11% in the eRCS group (p = 0.32). After adjustment, neonates born to women undergoing a TOL had no statistically significant difference in outcomes including composite neonatal outcome (adjusted odds ratio 0.86, 95% CI 0.68–1.09), neonatal intensive care unit admission, respiratory distress syndrome, necrotising enterocolitis, hypoxic ischaemic encephalopathy, seizures, transient tachypnoea of the newborn, compared with patients who underwent eRCS, with the exception of decreased risk of proven/suspected sepsis (adjusted odds ratio 0.68, 95% CI 0.52–0.87)
Conclusion
A TOL in preterm patients without a previous vaginal delivery was not found to have a statistically significant association with increased neonatal morbidity.
Tweetable
There is no statistically significant evidence of increased neonatal morbidity associated with a preterm trial of labour after previous caesarean delivery in patients without a previous vaginal delivery.