Bokkers, T. (Tom) (2021) A decline in successful trial of labor after cesarean, a single center cohort study. thesis, Medicine.
Full text available on request.Abstract
Background Cesarean section rates have shown a sharp increase in some countries while other countries lack access to this surgical procedure. In the Netherlands, the cesarean section rate is comparatively low but needs to be evaluated further. A key method for reducing cesarean section rates is a trial of labor after cesarean (TOLAC). We suspected a decline in TOLAC success rate due to fear of uterine rupture. The primary aim of our study was to describe the TOLAC (success) rate and the resulting vaginal birth after cesarean rate (VBAC). Methods A retrospective single-center cohort study describing characteristics of pregnancies when TOLAC was attempted. Successful and the unsuccessful TOLAC groups were compared in the years 2000 and 2017 to also identify changes in care over time. Results The TOLAC success rate and VBAC rate were 75.5% and 50.4% in 2000 compared to 61.1% and 35.2% in 2017, respectively. Fetal distress (including suspected uterine rupture) was significantly more frequent an indication for cesarean section in 2017 versus 2000. Furthermore, an association with oxytocin augmentation, induction of labor, epidural anesthesia and failure of TOLAC was seen. Conclusion Our study revealed a declining TOLAC success rate with an associated declining VBAC rate when comparing TOLAC patients between 2000 and 2017. Our findings indicate that this decline is due to an increased proportion of cesarean sections due to fetal distress and suspected uterine rupture. Future perspectives We recommend the incorporation of TOLAC patients in the national perinatal audit registry of ‘Perined’.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Gordijn, dr. S. (Sanne) and Elvan, dr. A. (Ayten) |
| Faculty: | Medical Sciences |
| Date Deposited: | 04 Jan 2022 10:07 |
| Last Modified: | 04 Jan 2022 10:07 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2928 |
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