Neonatal outcomes following a trial of labor after Caesarean delivery: a population-based study.

OBJECTIVE

To evaluate the neonatal effects of trial of labor after Caesarean (TOLAC) births.

METHODS

We conducted a retrospective population-based cohort study using the CDC's Period Linked Birth/Infant Death Public Use File (2011-2013) on women with a live singleton pregnancy and prior Caesarean delivery. Multivariate logistic regression compared neonatal outcomes between women who underwent a TOLAC with women who did not. Secondary analysis compared outcomes of birth with uterine rupture to those without.

RESULTS

A total of 1,036,554 births met inclusion criteria, of which 17.5% underwent TOLAC. Women who had a TOLAC were more likely to deliver infants requiring neonatal intensive care unit (NICU) admission (odds ratios (OR) 1.12, 95%CI 1.09-1.16) and assisted ventilation (OR 1.07, 95%CI 1.03-1.12). Among women with TOLAC, 0.18% of births were in context of a uterine rupture and those neonates had an increased risk of NICU admissions (OR 5.95, 95%CI 4.56-7.76), assisted ventilation (OR 8.89, 95%CI 6.73-11.75), seizures (OR 91.66, 95%CI 42.23-198.93), and death (OR 16.28, 95%CI 5.09-52.08).

CONCLUSIONS

Neonatal morbidity appears slightly increased among women with a TOLAC. However, morbidity and mortality are considerably increased in cases of uterine rupture. Appropriate selection and counseling of women for TOLAC should be undertaken as to minimize uterine rupture risk.