ArticleGeburtshilfe und Frauenheilkunde2025
Successful Trial of Labor After Two Caesarean Sections (TOLA2C): Analysis of a Delivery Protocol with Feto-Maternal Outcome.
Article in Geburtshilfe und Frauenheilkunde, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07258459 (Trial of Labor After Two CS Before and After Training a Protocol Introduction), which is not on this map. Not yet cited in PubMed.
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Trial of Labor After Two CS Before and After Training a Protocol Introduction
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7 authors.
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Abstract
Introduction: The majority of obstetrical clinics do not offer a trial of labor after two Caesarean sections (TOLA2C) due to concerns about fetal and maternal complications such as uterine rupture or asphyxia. This study aimed to establish a delivery protocol for safely undergoing TOLA2C and analyzed predictors for a successful vaginal delivery. Methods: Analysis of retrospectively collected data of all pregnant women after two consecutive Caesarean sections was performed at the Obstetrics Department of a tertiary community hospital from January 2013 until December 2022. Those who desired TOLA2C were screened by a senior obstetrician and had to consent to a delivery protocol consisting of five pre- and eight peripartum criteria. Maternal demographic data, indications for previous Caesarean sections and feto-maternal outcome parameters were compared between the successful TOLA2C group and the intrapartum Third-Caesarean section group. Results: In the study period, 385 women planned a delivery after two consecutive CS. Following the protocol, 358 patients (93.0%) were scheduled as elective repeat CS, while 27 (7.0%) attempted vaginal delivery. In this TOLA2C group, 17 women (63.0%) successfully delivered vaginally. In contrast, ten failed vaginal attempts (37.0%) resulted in nine intrapartum repeat CS and one intrapartum emergency CS. Women with prior vaginal delivery had a higher chance of a successful TOLA2C (p = 0.04). In comparison, women with a previous CS due to the indication of arrested labor had a higher risk for intrapartum repeat CS (p = 0.02). No fetal or maternal death occurred, and no major complications were observed. Conclusion: Under the specified conditions, TOLA2C is safe for mother and fetus, and successful vaginal delivery is feasible.
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