Uterine Rupture and Vaginal Birth After Cesarean Rate After Implementation of Restrictive Trial of Labor After Cesarean Induction of Labor Eligibility Policy [ID 961]

INTRODUCTION: After an increase in labor induction-associated uterine rupture cases, our institution implemented a restrictive trial of labor after cesarean (TOLAC) induction of labor (IOL) eligibility policy. The policy did not allow elective IOL to TOLAC patients and denied medically indicated IOL to patients who met any of the following criteria: two or more cesarean deliveries; body mass index greater or equal to 50 AND without a prior vaginal delivery; a priori predicted success rate of less than 60% AND Bishop score of less than 8. We investigated how this policy affected uterine rupture and VBAC rates. METHODS: This was a retrospective cohort of 4,356 participants with a prior cesarean delivery who delivered a subsequent neonate between 2011 and 2022. Uterine rupture rates were compared before and after implementation of the eligibility policy in 2018. The primary outcomes were uterine rupture and rates of VBAC. Multivariable logistic regression was performed. RESULTS: The uterine rupture rate decreased by 50% after implementation of eligibility criteria (0.9% pre-policy, 0.5% post-policy). The VBAC rate decreased from 30% to 25%, whereas the unsuccessful TOLAC rate decreased from 7.3% to 5%. CONCLUSIONS/IMPLICATIONS: This study supports previous studies that demonstrate IOL in TOLAC patients may increase the risk of uterine rupture. Restrictive criteria for IOL in TOLAC patients decreased the rates of uterine rupture and unsuccessful TOLAC, however decreased the overall VBAC rate. Uterine rupture is a rare, yet catastrophic event, and more studies are needed to develop policies that minimize risk to TOLAC patients and maximize VBAC rates.