Trial of labour following two previous caesarean sections – A UK cohort study (2024)

McMullan, J. C., Creswell, L., Frazer, M., McFetridge, L., Mitchell, H., Coyne, C., Manderson, J. G., Murnaghan, M. (Accepted/In press). Trial of labour following two previous caesarean sections – A UK cohort study. European Journal of Obstetrics, Gynaecology and Reproductive Biology.

McMullan, Josh Courtney ; Creswell, Lyndsay ; Frazer, Megan et al. / Trial of labour following two previous caesarean sections – A UK cohort study. In: European Journal of Obstetrics, Gynaecology and Reproductive Biology. 2024.

@article{791236379098425ba6fdf499dc123cf7,

title = "Trial of labour following two previous caesarean sections – A UK cohort study",

abstract = "Objectives: To assess the (i) predictors of and associated rates of success and; (ii) maternal and perinatal outcomesof women undergoing trial of labour after two previous caesarean sections (TOLA2C).Study design: This retrospective cohort study collected data from two regional obstetric centres with 12,000 deliveriesper annum collectively. The population included singleton pregnancies undergoing (i) TOLA2C, (ii) electiverepeat caesarean section following two caesarean sections (ERCS) and (iii) trial of labour after one caesareansection (TOLA1C). Data was collected electronically from 2013 to 2021. Statistical analysis includedFisher exact and Kruskal-Wallis test to compare unpaired samples alongside univariate and multivariable logisticregression. The primary outcome measure was maternal and perinatal outcome.Results: The three groups included; n = 146 TOLA2C, n = 206 ERCS and n = 99 TOLA1C. TOLA2C had a successrate of 65 % compared to 74 % for TOLA1C (p = 0.16). The optimal predictor of successful TOLA2C wasprevious successful TOLA1C OR 8.65 (95 % CI 2.75–38.41). TOLA2C was associated with greater risk of endometritisand/or sepsis postnatally compared to the other two groups [10.3 % (n = 15) versus 0.5 % (n = 1)and 3 % (n = 3) for ERCS and TOLA1C respectively p < 0.01]. It was also associated with longer maternalhospital stay [2.4 days (+/-1.8) versus 1.8 (+/-0.8) and 1.8 (+/-1.7) p < 0.01], a greater proportion ofneonates with Apgar scores less than 7 (p=<0.01) and higher rates of neonatal unit admission [14 %(n = 20) versus 5 % (n = 11) versus 4 % (n = 4) (p=<0.01)].Conclusion: Women considering trial of labour following two caesarean sections should be counselled regardingthe potential increased risk of endometritis, sepsis and adverse neonatal outcome.",

keywords = "vagin*l Birth after Cesarean, Caesarean section",

author = "McMullan, {Josh Courtney} and Lyndsay Creswell and Megan Frazer and Lisa McFetridge and Hannah Mitchell and Colm Coyne and Manderson, {John G} and Mary Murnaghan and Fionnuala Mone",

year = "2024",

month = may,

day = "19",

language = "English",

journal = "European Journal of Obstetrics, Gynaecology and Reproductive Biology",

issn = "0301-2115",

publisher = "Elsevier Ireland Ltd",

}

McMullan, JC, Creswell, L, Frazer, M, McFetridge, L, Mitchell, H, Coyne, C, Manderson, JG, Murnaghan, M 2024, 'Trial of labour following two previous caesarean sections – A UK cohort study', European Journal of Obstetrics, Gynaecology and Reproductive Biology.

Trial of labour following two previous caesarean sections – A UK cohort study. / McMullan, Josh Courtney; Creswell, Lyndsay; Frazer, Megan et al.
In: European Journal of Obstetrics, Gynaecology and Reproductive Biology, 19.05.2024.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Trial of labour following two previous caesarean sections – A UK cohort study

AU - McMullan, Josh Courtney

AU - Creswell, Lyndsay

AU - Frazer, Megan

AU - McFetridge, Lisa

AU - Mitchell, Hannah

AU - Coyne, Colm

AU - Manderson, John G

AU - Murnaghan, Mary

AU - Mone, Fionnuala

PY - 2024/5/19

Y1 - 2024/5/19

N2 - Objectives: To assess the (i) predictors of and associated rates of success and; (ii) maternal and perinatal outcomesof women undergoing trial of labour after two previous caesarean sections (TOLA2C).Study design: This retrospective cohort study collected data from two regional obstetric centres with 12,000 deliveriesper annum collectively. The population included singleton pregnancies undergoing (i) TOLA2C, (ii) electiverepeat caesarean section following two caesarean sections (ERCS) and (iii) trial of labour after one caesareansection (TOLA1C). Data was collected electronically from 2013 to 2021. Statistical analysis includedFisher exact and Kruskal-Wallis test to compare unpaired samples alongside univariate and multivariable logisticregression. The primary outcome measure was maternal and perinatal outcome.Results: The three groups included; n = 146 TOLA2C, n = 206 ERCS and n = 99 TOLA1C. TOLA2C had a successrate of 65 % compared to 74 % for TOLA1C (p = 0.16). The optimal predictor of successful TOLA2C wasprevious successful TOLA1C OR 8.65 (95 % CI 2.75–38.41). TOLA2C was associated with greater risk of endometritisand/or sepsis postnatally compared to the other two groups [10.3 % (n = 15) versus 0.5 % (n = 1)and 3 % (n = 3) for ERCS and TOLA1C respectively p < 0.01]. It was also associated with longer maternalhospital stay [2.4 days (+/-1.8) versus 1.8 (+/-0.8) and 1.8 (+/-1.7) p < 0.01], a greater proportion ofneonates with Apgar scores less than 7 (p=<0.01) and higher rates of neonatal unit admission [14 %(n = 20) versus 5 % (n = 11) versus 4 % (n = 4) (p=<0.01)].Conclusion: Women considering trial of labour following two caesarean sections should be counselled regardingthe potential increased risk of endometritis, sepsis and adverse neonatal outcome.

AB - Objectives: To assess the (i) predictors of and associated rates of success and; (ii) maternal and perinatal outcomesof women undergoing trial of labour after two previous caesarean sections (TOLA2C).Study design: This retrospective cohort study collected data from two regional obstetric centres with 12,000 deliveriesper annum collectively. The population included singleton pregnancies undergoing (i) TOLA2C, (ii) electiverepeat caesarean section following two caesarean sections (ERCS) and (iii) trial of labour after one caesareansection (TOLA1C). Data was collected electronically from 2013 to 2021. Statistical analysis includedFisher exact and Kruskal-Wallis test to compare unpaired samples alongside univariate and multivariable logisticregression. The primary outcome measure was maternal and perinatal outcome.Results: The three groups included; n = 146 TOLA2C, n = 206 ERCS and n = 99 TOLA1C. TOLA2C had a successrate of 65 % compared to 74 % for TOLA1C (p = 0.16). The optimal predictor of successful TOLA2C wasprevious successful TOLA1C OR 8.65 (95 % CI 2.75–38.41). TOLA2C was associated with greater risk of endometritisand/or sepsis postnatally compared to the other two groups [10.3 % (n = 15) versus 0.5 % (n = 1)and 3 % (n = 3) for ERCS and TOLA1C respectively p < 0.01]. It was also associated with longer maternalhospital stay [2.4 days (+/-1.8) versus 1.8 (+/-0.8) and 1.8 (+/-1.7) p < 0.01], a greater proportion ofneonates with Apgar scores less than 7 (p=<0.01) and higher rates of neonatal unit admission [14 %(n = 20) versus 5 % (n = 11) versus 4 % (n = 4) (p=<0.01)].Conclusion: Women considering trial of labour following two caesarean sections should be counselled regardingthe potential increased risk of endometritis, sepsis and adverse neonatal outcome.

KW - vagin*l Birth after Cesarean

KW - Caesarean section

M3 - Article

SN - 0301-2115

JO - European Journal of Obstetrics, Gynaecology and Reproductive Biology

JF - European Journal of Obstetrics, Gynaecology and Reproductive Biology

ER -

McMullan JC, Creswell L, Frazer M, McFetridge L, Mitchell H, Coyne C et al. Trial of labour following two previous caesarean sections – A UK cohort study. European Journal of Obstetrics, Gynaecology and Reproductive Biology. 2024 May 19.