Labor patterns in women attempting vaginal birth after cesarean with normal neonatal outcomes - 18/05/15

Doi : 10.1016/j.ajog.2015.04.033

Katherine L. Grantz, MD, MS ^a,^⁎ , Victor Gonzalez-Quintero, MD, MPH ^e, James Troendle, PhD ^d, Uma M. Reddy, MD, MPH ^b, Stefanie N. Hinkle, PhD ^a, Michelle A. Kominiarek, MD, MS ^f, Zhaohui Lu, MS ^c, Jun Zhang, PhD, MD ^g
^a Epidemiology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
^b Pregnancy and Perinatology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
^c Glotech Inc, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
^d Office of Biostatistics Research, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
^e Department of Obstetrics and Gynecology, University of Miami School of Medicine, Miami, FL
^f Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Illinois College of Medicine at Chicago, Chicago, IL
^g MOE-Shanghai Key Lab of Children’s Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

^∗Corresponding author: Katherine L. Grantz, MD, MS.

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Abstract

Objective

We sought to describe labor patterns in women with a trial of labor after cesarean (TOLAC) with normal neonatal outcomes.

Study Design

In a retrospective observational study at 12 US centers (2002 through 2008), we examined time interval for each centimeter of cervical dilation and compared labor progression stratified by spontaneous or induced labor in 2892 multiparous women with TOLAC (second delivery) and 56,301 nulliparous women at 37 0/7 to 41 6/7 weeks of gestation. Analyses were performed including women with intrapartum cesarean delivery, and also limiting only to women who delivered vaginally.

Results

Labor was induced in 23.4% of TOLAC and 44.1% of nulliparous women (P < .001). Cesarean delivery rates were 57.7% in TOLAC vs 19.0% in nulliparous women (P < .001). Oxytocin was used in 52.4% of TOLAC vs 64.3% of nulliparous women with spontaneous labor (P < .001) and 89.8% of TOLAC vs 91.6% of nulliparous women with induced labor (P = .099); however, TOLAC had lower maximum doses of oxytocin compared to nulliparous women: median (90th percentile): 6 (18) mU/min vs 12 (28) mU/min, respectively (P < .001). Median (95th percentile) labor duration for TOLAC vs nulliparous women with spontaneous labor from 4-10 cm was 0.9 (2.2) hours longer (P = .007). For women who entered labor spontaneously and achieved vaginal delivery, labor patterns for TOLAC were similar to nulliparous women. For induced labor, labor duration for TOLAC vs nulliparous women from 4-10 cm was 1.5 (4.6) hours longer (P < .001). For women who achieved vaginal delivery, labor patterns were slower for induced TOLAC compared to nulliparous women.

Conclusion

Labor duration for TOLAC was slower compared to nulliparous labor, particularly for induced labor. By improved understanding of the rates of progress at different points in labor, this new information on labor curves in women undergoing TOLAC, particularly for induction, should help physicians when managing labor.

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Key words : first stage of labor, trial of labor after cesarean, vaginal birth after cesarean

Plan

Materials and Methods

Statistical analysis

Results

Comment

	Institutions involved in the Consortium on Safe Labor are named in the Acknowledgments.
	The funding source had no role in study design; in the collection, analysis, or interpretation of data; in the writing of the report; or in the decision to submit the article for publication, although the manuscript did receive clearance for submission for publication.
	This research was supported by the Intramural Research Program of the National Institutes of Health, Eunice Kennedy ShriverNational Institute of Child Health and Human Development (NICHD). The Consortium on Safe Labor was funded by the Intramural Research Program of the NICHD through contract number HHSN267200603425C.
	The authors report no conflict of interest.
	Drs Grantz, Troendle, and Reddy are employees of the federal government. The named authors alone are responsible for the views expressed in this manuscript, which does not necessarily represent the decisions or the stated policy of the NICHD.
	Cite this article as: Grantz KL, Gonzalez-Quintero V, Troendle J, et al. Labor patterns in women attempting vaginal birth after cesarean with normal neonatal outcomes. Am J Obstet Gynecol 2015;213:x.ex-x.ex.