Adverse perinatal outcomes associated with trial of labor after cesarean section at term in pregnancies complicated by maternal obesity

Ruofan Yao; Sarah D. Crimmins; Stephen A. Contag; Jerome N. Kopelman; Katherine R. Goetzinger

doi:10.1080/14767058.2017.1404023

Adverse perinatal outcomes associated with trial of labor after cesarean section at term in pregnancies complicated by maternal obesity

Ruofan Yao, Sarah D. Crimmins, Stephen A. Contag, Jerome N. Kopelman, Katherine R. Goetzinger

Obstetrics, Gynecology and Women's Health - Fetal Medicine

Research output: Contribution to journal › Article › peer-review

14 Scopus citations

Abstract

INTRODUCTION: Obesity is associated with higher risks for intrapartum complications. Therefore, we sought to determine if trial of labor after cesarean section (TOLAC) will lead to higher maternal and neonatal complications compared to repeat cesarean section (RCD).

METHODS: This was a retrospective cohort analysis of singleton nonanomalous births between 37 and 42 weeks GA complicated by maternal obesity (body mass index (BMI) ≥ 30 kg/m 2) and history of one or two previous cesarean deliveries. Outcomes were compared between TOLAC and RCD. The maternal outcomes of interest included blood transfusion, uterine rupture, hysterectomy, and intensive care unit admission. Neonatal outcomes of interest included 5-minute Apgar score <7, prolonged assisted ventilation, neonatal intensive care unit admission, neonatal seizures, and neonatal death.

RESULTS: There were 538,264 pregnancies included. Compared with RCD, TOLAC was associated with an absolute increase in the following neonatal outcomes: low 5-min Apgar score (0.6%, p < .001), neonatal intensive care unit (NICU) admission (0.8%, p < .001), neonatal seizure (0.1 per 1000 births, p = .037), and neonatal death (0.2 per 1000 births, p = .028). Additionally, TOLAC was associated with an absolute increase in following maternal outcomes: blood transfusion (0.1%, p < .001), uterine rupture (0.18%, p < .001) and ICU admission (0.1%, p = .011).

CONCLUSIONS: TOLAC among obesity pregnancies at term increases the risk of maternal and neonatal complications compared with RCD.

Original language	English (US)
Pages (from-to)	1256-1261
Number of pages	6
Journal	Journal of Maternal-Fetal and Neonatal Medicine
Volume	32
Issue number	8
DOIs	https://doi.org/10.1080/14767058.2017.1404023
State	Published - Apr 18 2019

Bibliographical note

Publisher Copyright:
© 2017, © 2017 Informa UK Limited, trading as Taylor & Francis Group.

Keywords

TOLAC
VBAC
maternal outcomes
neonatal outcomes
obesity
Cesarean Section, Repeat/adverse effects
Uterine Rupture/epidemiology
Intensive Care Units, Neonatal/statistics & numerical data
Risk Assessment
Humans
Vaginal Birth after Cesarean/adverse effects
Pregnancy
Blood Transfusion/statistics & numerical data
Trial of Labor
Apgar Score
Pregnancy Complications/epidemiology
Obesity/complications
Adult
Female
Retrospective Studies
Term Birth

PubMed: MeSH publication types

Journal Article
Comparative Study

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1080/14767058.2017.1404023

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@article{a85200c2dfab43acb2370dd765b1971a,

title = "Adverse perinatal outcomes associated with trial of labor after cesarean section at term in pregnancies complicated by maternal obesity",

abstract = "INTRODUCTION: Obesity is associated with higher risks for intrapartum complications. Therefore, we sought to determine if trial of labor after cesarean section (TOLAC) will lead to higher maternal and neonatal complications compared to repeat cesarean section (RCD).METHODS: This was a retrospective cohort analysis of singleton nonanomalous births between 37 and 42 weeks GA complicated by maternal obesity (body mass index (BMI) ≥ 30 kg/m 2) and history of one or two previous cesarean deliveries. Outcomes were compared between TOLAC and RCD. The maternal outcomes of interest included blood transfusion, uterine rupture, hysterectomy, and intensive care unit admission. Neonatal outcomes of interest included 5-minute Apgar score <7, prolonged assisted ventilation, neonatal intensive care unit admission, neonatal seizures, and neonatal death. RESULTS: There were 538,264 pregnancies included. Compared with RCD, TOLAC was associated with an absolute increase in the following neonatal outcomes: low 5-min Apgar score (0.6%, p < .001), neonatal intensive care unit (NICU) admission (0.8%, p < .001), neonatal seizure (0.1 per 1000 births, p = .037), and neonatal death (0.2 per 1000 births, p = .028). Additionally, TOLAC was associated with an absolute increase in following maternal outcomes: blood transfusion (0.1%, p < .001), uterine rupture (0.18%, p < .001) and ICU admission (0.1%, p = .011).CONCLUSIONS: TOLAC among obesity pregnancies at term increases the risk of maternal and neonatal complications compared with RCD.",

keywords = "TOLAC, VBAC, maternal outcomes, neonatal outcomes, obesity, Cesarean Section, Repeat/adverse effects, Uterine Rupture/epidemiology, Intensive Care Units, Neonatal/statistics & numerical data, Risk Assessment, Humans, Vaginal Birth after Cesarean/adverse effects, Pregnancy, Blood Transfusion/statistics & numerical data, Trial of Labor, Apgar Score, Pregnancy Complications/epidemiology, Obesity/complications, Adult, Female, Retrospective Studies, Term Birth",

author = "Ruofan Yao and Crimmins, {Sarah D.} and Contag, {Stephen A.} and Kopelman, {Jerome N.} and Goetzinger, {Katherine R.}",

note = "Publisher Copyright: {\textcopyright} 2017, {\textcopyright} 2017 Informa UK Limited, trading as Taylor & Francis Group.",

year = "2019",

month = apr,

day = "18",

doi = "10.1080/14767058.2017.1404023",

language = "English (US)",

volume = "32",

pages = "1256--1261",

journal = "Journal of Maternal-Fetal and Neonatal Medicine",

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TY - JOUR

T1 - Adverse perinatal outcomes associated with trial of labor after cesarean section at term in pregnancies complicated by maternal obesity

AU - Yao, Ruofan

AU - Crimmins, Sarah D.

AU - Contag, Stephen A.

AU - Kopelman, Jerome N.

AU - Goetzinger, Katherine R.

PY - 2019/4/18

Y1 - 2019/4/18

N2 - INTRODUCTION: Obesity is associated with higher risks for intrapartum complications. Therefore, we sought to determine if trial of labor after cesarean section (TOLAC) will lead to higher maternal and neonatal complications compared to repeat cesarean section (RCD).METHODS: This was a retrospective cohort analysis of singleton nonanomalous births between 37 and 42 weeks GA complicated by maternal obesity (body mass index (BMI) ≥ 30 kg/m 2) and history of one or two previous cesarean deliveries. Outcomes were compared between TOLAC and RCD. The maternal outcomes of interest included blood transfusion, uterine rupture, hysterectomy, and intensive care unit admission. Neonatal outcomes of interest included 5-minute Apgar score <7, prolonged assisted ventilation, neonatal intensive care unit admission, neonatal seizures, and neonatal death. RESULTS: There were 538,264 pregnancies included. Compared with RCD, TOLAC was associated with an absolute increase in the following neonatal outcomes: low 5-min Apgar score (0.6%, p < .001), neonatal intensive care unit (NICU) admission (0.8%, p < .001), neonatal seizure (0.1 per 1000 births, p = .037), and neonatal death (0.2 per 1000 births, p = .028). Additionally, TOLAC was associated with an absolute increase in following maternal outcomes: blood transfusion (0.1%, p < .001), uterine rupture (0.18%, p < .001) and ICU admission (0.1%, p = .011).CONCLUSIONS: TOLAC among obesity pregnancies at term increases the risk of maternal and neonatal complications compared with RCD.

AB - INTRODUCTION: Obesity is associated with higher risks for intrapartum complications. Therefore, we sought to determine if trial of labor after cesarean section (TOLAC) will lead to higher maternal and neonatal complications compared to repeat cesarean section (RCD).METHODS: This was a retrospective cohort analysis of singleton nonanomalous births between 37 and 42 weeks GA complicated by maternal obesity (body mass index (BMI) ≥ 30 kg/m 2) and history of one or two previous cesarean deliveries. Outcomes were compared between TOLAC and RCD. The maternal outcomes of interest included blood transfusion, uterine rupture, hysterectomy, and intensive care unit admission. Neonatal outcomes of interest included 5-minute Apgar score <7, prolonged assisted ventilation, neonatal intensive care unit admission, neonatal seizures, and neonatal death. RESULTS: There were 538,264 pregnancies included. Compared with RCD, TOLAC was associated with an absolute increase in the following neonatal outcomes: low 5-min Apgar score (0.6%, p < .001), neonatal intensive care unit (NICU) admission (0.8%, p < .001), neonatal seizure (0.1 per 1000 births, p = .037), and neonatal death (0.2 per 1000 births, p = .028). Additionally, TOLAC was associated with an absolute increase in following maternal outcomes: blood transfusion (0.1%, p < .001), uterine rupture (0.18%, p < .001) and ICU admission (0.1%, p = .011).CONCLUSIONS: TOLAC among obesity pregnancies at term increases the risk of maternal and neonatal complications compared with RCD.

KW - TOLAC

KW - VBAC

KW - maternal outcomes

KW - neonatal outcomes

KW - obesity

KW - Cesarean Section, Repeat/adverse effects

KW - Uterine Rupture/epidemiology

KW - Intensive Care Units, Neonatal/statistics & numerical data

KW - Risk Assessment

KW - Humans

KW - Vaginal Birth after Cesarean/adverse effects

KW - Pregnancy

KW - Blood Transfusion/statistics & numerical data

KW - Trial of Labor

KW - Apgar Score

KW - Pregnancy Complications/epidemiology

KW - Obesity/complications

KW - Adult

KW - Female

KW - Retrospective Studies

KW - Term Birth

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DO - 10.1080/14767058.2017.1404023

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JO - Journal of Maternal-Fetal and Neonatal Medicine

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ER -

Adverse perinatal outcomes associated with trial of labor after cesarean section at term in pregnancies complicated by maternal obesity

Abstract

Bibliographical note

Keywords

PubMed: MeSH publication types

UN SDGs

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