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Trial of labor after Cesarean delivery for estimated large for gestational age fetuses: a retrospective cohort study
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  • Aya Mohr-Sasson,
  • Or Bercovich,
  • Zohar Goichberg,
  • Hadel Watad,
  • Kiss Salim,
  • Shali Mazaki-Tovi,
  • Eyal Sivan,
  • Israel Hendler
Aya Mohr-Sasson
The Chaim Sheba Medical Center
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Or Bercovich
Tel Aviv University Sackler Faculty of Medicine
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Zohar Goichberg
Tel HaShomer Hospital
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Hadel Watad
Tel HaShomer Hospital
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Kiss Salim
Tel HaShomer Hospital
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Shali Mazaki-Tovi
Sheba Medical Center, Tel-Hashomer, Israel 52621; Sackler School of Medicine, Tel Aviv University, Tel Aviv Israel 69978
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Eyal Sivan
The Chaim Sheba Medical Center
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Israel Hendler
Tel HaShomer Hospital
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Abstract

Objective: Estimated fetal weight, large for gestational age (eLGA) (≥90th percentile) may be associated with failed trial of labor after Cesarean (TOLAC), like fetal macrosomia. The aim of this study was to evaluate obstetrical outcome and safety of TOLAC, for women with eLGA. Design: A retrospective cohort study. Setting: a single large tertiary care center. Population or Sample: all women with singleton pregnancy, gestational age ≥ 37weeks, admitted for TOLAC between 2012 and 2017. Methods: Women with eLGA were compared to women with EFW < 90th percentile. Main outcome measures: the rate of successful vaginal delivery, adverse obstetrical outcomes. Results: 1949 women met inclusion criteria, including78 (4%) eLGA and 1871 (96%) controls. Study group were older (35 vs. 33 year; p=0.004), with higher Body Mass Index (30.9 vs. 27.5 kg/m2; p=0.001) and higher gravidity (4 vs. 3; p=0.001) compared to the controls. Median fetal weight was [3887g (IQR 3718-4073) vs. 3275g (IQR 2995-3545); p=0.001 in the study vs. controls respectively]. 55 (70.5%) women in the study group had successful vaginal delivery compared to 1506 (80.5%) women in the control (p= 0.03). The rate of obstetrical complications, including: scar dehiscence, uterine rupture, 3rd /4th degree perineal tear or shoulder dystocia were comparable. The rate of post-partum hemorrhage was increased in the study group compared to controls (7.7% vs.1.7%; p=0.001). Conclusion: TOLAC for eLGA fetuses can be considered as safe, however, lower successful VBAC rates and increased PPH rate may be expected.