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Archives of Gynecology and Obstetrics

Erschienen in:

30.09.2023 | Maternal-Fetal Medicine

Trial of labor following cesarean in patients with bicornuate uterus: a multicenter retrospective study

verfasst von: Reut Rotem, Ayala Hirsch, Zvi Ehrlich, Hen Y. Sela, Sorina Grisaru-Granovsky, Misgav Rottenstreich

Erschienen in: Archives of Gynecology and Obstetrics | Ausgabe 1/2024

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Abstract

Objective

This study aimed to evaluate whether a trial of labor after cesarean delivery (TOLAC) in women with a bicornuate uterus is associated with increased maternal and neonatal morbidity compared to women with a non-malformed uterus.

Methods

A multicenter retrospective cohort study was conducted at two university-affiliated centers between 2005 and 2021. Parturients with a bicornuate uterus who attempted TOLAC following a single low-segment transverse cesarean delivery (CD) were included and compared to those with a non-malformed uterus. Failed TOLAC rates and the rate of adverse maternal and neonatal outcomes were compared using both univariate and multivariate analyses.

Results

Among 20,844 eligible births following CD, 125 (0.6%) were identified as having a bicornuate uterus. The overall successful vaginal delivery rate following CD in the bicornuate uterus group was 77.4%. Failed TOLAC rates were significantly higher in the bicornuate group (22.4% vs. 10.5%, p < 0.01). Uterine rupture rates did not differ between the groups, but rates of placental abruption and retained placenta were significantly higher among parturients with a bicornuate uterus (9.8% vs. 4.4%, p < 0.01, and 9.8% vs. 4.4%, p < 0.01, respectively). Neonatal outcomes following TOLAC were less favorable in the bicornuate group, particularly in terms of neonatal intensive care unit admission and neonatal sepsis. Multivariate analysis revealed an independent association between the bicornuate uterus and failed TOLAC.

Conclusions

This study found that parturients with a bicornuate uterus who attempted TOLAC have a relatively high overall rate of vaginal birth after cesarean (VBAC). However, their chances of achieving VBAC are significantly lower compared to those with a non-malformed uterus. Obstetricians should be aware of these findings when providing consultation to patients.

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Titel: Trial of labor following cesarean in patients with bicornuate uterus: a multicenter retrospective study
verfasst von: Reut Rotem
Ayala Hirsch
Zvi Ehrlich
Hen Y. Sela
Sorina Grisaru-Granovsky
Misgav Rottenstreich
Publikationsdatum: 30.09.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: Archives of Gynecology and Obstetrics / Ausgabe 1/2024
Print ISSN: 0932-0067
Elektronische ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-023-07220-4

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Trial of labor following cesarean in patients with bicornuate uterus: a multicenter retrospective study