For a study, researchers sought to see if fetal head station at the index cesarean delivery is linked to a future trial of labor success rate in primiparous women. A retrospective cohort research at two tertiary medical facilities included all primiparous women who had a subsequent birth following cesarean delivery for second-stage dystocia between 2009 and 2019, as identified in electronic medical record databases. The characteristics associated with successful trials of labor after cesarean (TOLAC) were evaluated using univariate and multivariate analysis (primary outcome). Furthermore, according to the parameters revealed in the univariate analysis, all women who failed TOLAC were paired one-to-one with women who passed TOLAC.
About 64% (n=310) of 481 primiparous women who had previously had a cesarean birth for second-stage dystocia tried TOLAC, and 222 (71.6%) delivered vaginally. Those with the fetal head position below the ischial spines at the index cesarean delivery had a substantially greater rate of successful TOLAC (79.0% vs 60.5%, odds ratio [OR] 2.46, 95% CI 1.49–4.08) than those with the higher head station. When comparing individuals who had successful TOLAC to those who had failed TOLAC, the proportion of newborns weighing more than 3,500 g in the subsequent birth was lower (29.7% vs 43.2%, OR 0.56, 95% CI: 0.33–0.93). The sole independent predictor related to TOLAC success (adjusted OR 2.38, 95% CI: 1.43–3.96) in the multivariable analysis was lower fetal head station at the index cesarean delivery (adjusted OR 2.38, 95% CI: 1.43–3.96). When all women who had a failed TOLAC were matched one-to-one with women who had a successful TOLAC based on birth weight and second-stage length at the following delivery, the lower fetal head station at the index cesarean delivery remained the only predictor associated with a successful TOLAC.
Lower fetal head station after the index cesarean delivery for second-stage dystocia was linked to a higher vaginal birth after cesarean rate, with an overall acceptable success rate. These findings could help to enhance patient counseling and comfort women who want to give birth vaginally after a second-stage arrest.