Maternal, Obstetrical, and Neonatal Outcomes Associated With TOLAC Success and Failure in the U.S. Population [ID 1338]

INTRODUCTION: We aimed to examine the obstetrical and neonatal outcome differences between successful and unsuccessful trials of labor after cesarean delivery (TOLACs) in the contemporary United States. METHODS: A retrospective analysis of the Centers for Disease Control and Prevention’s Natality live birth database (2016–2022) was performed. We included term (37 0/7 to 40 6/7 weeks), singleton pregnancies with prior cesarean delivery who attempted TOLAC. The study group included individuals with successful TOLAC. The comparison group included those with repeat cesarean births after failed TOLAC. Maternal and neonatal outcomes were compared using Pearson’s chi-squared test. Results were presented as odds ratios (ORs) with 95% CIs. Statistical significance was defined as P <.05. RESULTS: Of the 2,313,494 individuals who attempted TOLAC, 469,020 (20.3%) were successful. The prevalence of successful TOLAC was low in the following outcome groups: maternal intensive care unit (ICU) admission (OR 0.30; CI, 0.28–0.33), use of maternal antibiotics (OR 0.049; CI, 0.047–0.0.50), uterine rupture (OR 0.39; CI, 0.34–0.44), low birth weight (OR 0.807; CI, 0.792–0.822), immediate assisted neonatal ventilation (OR 0.44; CI, 0.43–0.45), 6 hours of neonatal ventilation (OR 0.62; CI, 0.60–0.64), neonatal ICU admission (OR 0.559; CI, 0.551–0.568), and low 5-minute APGAR scores (OR 0.455; CI, 0.443–0.467). CONCLUSIONS/IMPLICATIONS: We provide an updated appraisal of several maternal and neonatal complications that are associated with failed TOLAC. These findings may assist providers in counseling individuals desiring TOLAC about the risks and benefits.