| Trial of labor after cesarean section in twin pregnancies: maternal and neonatal safety. | |
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MedLine Citation:
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PMID: 19658041 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To assess maternal and perinatal morbidity in patients undergoing a trial of labor after cesarean section (TOLAC) in twin gestations. METHODS: A retrospective study including all twin pregnancies with a single prior cesarean section was performed. Stratified analysis using a multiple logistic regression model was performed to control for confounders. Patients who had a clear medical indication for a cesarean section (i.e. previous corporeal cesarean section, breech or transverse presentation, placenta previa, placental abruption, and herpes infection) were excluded from the analysis. RESULTS: During the years 1988-2007, 134 patients met the inclusion criteria. Of these, 25 patients underwent a trial of labor and the remaining 109 underwent a repeat cesarean delivery. There were no cases of uterine rupture, maternal mortality, or peripartum fever in our population. Higher rates of perinatal mortality were noted in patients undergoing a trial of labor (8% vs. 1.8%, p = 0.042, OR = 4.652, 95% CI = 1.122-19.286). However, a trial of labor was not found to be an independent risk factor for perinatal mortality after controlling for confounders such as gestational age, ethnicity, and fetal malformations (adjusted OR = 1.07, 95% CI = 0.07-15.95, p = 0.95). CONCLUSIONS: A TOLAC is not associated with an increased risk for maternal morbidity, including uterine rupture. Nevertheless, in our population TOLAC was noted as a risk factor for perinatal mortality, although residual confounding cannot be excluded. Further prospective randomized studies should evaluate the safety of TOLAC in twin gestations to establish appropriate guidelines. |
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Authors:
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Daniel Aaronson; Avi Harlev; Eyal Sheiner; Amalia Levy |
Publication Detail:
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Type: Evaluation Studies; Journal Article |
Journal Detail:
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Title: The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians Volume: 23 ISSN: 1476-4954 ISO Abbreviation: J. Matern. Fetal. Neonatal. Med. Publication Date: 2010 Jun |
Date Detail:
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Created Date: 2010-05-17 Completed Date: 2010-09-01 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101136916 Medline TA: J Matern Fetal Neonatal Med Country: England |
Other Details:
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Languages: eng Pagination: 550-4 Citation Subset: IM |
Affiliation:
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Faculty of Health Sciences, The Joyce and Irving Goldman Medical School, Ben-Gurion University of Negev, Be'er-Sheva, Israel. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Cesarean Section, Repeat
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statistics & numerical data Female Gestational Age Humans Infant Mortality Infant, Newborn Models, Biological Mothers / statistics & numerical data Obstetric Labor Complications / epidemiology* Pregnancy Pregnancy Outcome Pregnancy, Multiple / physiology, statistics & numerical data* Retrospective Studies Safety Trial of Labor* Twins* Vaginal Birth after Cesarean / adverse effects, statistics & numerical data* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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