Strength and Limitations
Our study included a large cohort that was assembled from a single tertiary university affiliated medical center. To the best of our knowledge this is the first study to describe obstetrical outcome of women going through trial of labor after Cesarean delivery with large estimated fetal weight adjusted for gestational week.
An accurate estimation of fetal weight is important to clinical decision making. In our study, estimation of fetal weight were similar to neonatal weight both in the study group (median 3900g and 3887g, respectively) and in the control group (median 3200g and 3275g, respectively).
Our study is not without limitations. This is a retrospective study. The observational design limited our ability to infer a causal relationship between success rate and large estimation of fetal weight. Furthermore, lack of randomization due to study design might have introduced a bias. A small sample size may obscure our ability to define the rate of uterine rupture and uterine dehiscence in both groups.
Moreover, the ultrasound examinations performed in this study as a part of the routine care in our tertiary center are not routinely done in all medical centers, this might limit the applicability of our findings to different practice settings.