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TOLACTrial of Labor After Cesarean
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Therefore, epidural analgesia for labor may be used as part of TOLAC, and adequate pain relief may encourage more women to choose TOLAC.
11) TOLAC may increase rate of vaginal delivery with a small increase in neonatal morbidity.
Women who presented with H/O recurrent indication like CPD with no living issue, IUGR and severe oligohydramnios, with foetal distress and non-reassuring FHS and not willing for TOLAC were taken up for repeat L.
Table-2: Comparison of means of maternal characteristics, labour and birth outcomes in women with successful and unsuccessful TOLAC (n = 95).
This then allowed us to uniquely develop TOLAC and ERCD groups with well balanced covariates with minimal bias.
These principles were extremely valuable in obtaining informed consent for a TOLAC and ensuring the N family's comprehension and consent during the postpartum repair.
Some data have suggested an association between TOLAC and uterine rupture (1).
1) Furthermore, only 28% of women attempt a TOLAC, with a successful vaginal birth after cesarean (VBAC) rate of approximately 57%.
Several European countries have TOLAC rates between 50% and 70%, but in the United States, as evidenced by the recent CDC data, there continues to be an underutilization of attempted VBAC.
All the women fulfilling the selection criteria for TOLAC like definite history of prior one lower segment caesarean section, patient willing for trial of labor, gestation age >37 completed weeks, clinically adequate pelvis, single live fetus, vertex presentation, inter delivery interval>24 months were counseled about TOLAC, success rate of VBAC and all the risks and benefits associated with VBAC.
The researchers also found that this risk for failed TOLAC was present for a secondary study cohort of 500 women at low risk for complications (nonmedically indicated inductions).