Material and Methods
A retrospective cohort study including all women admitted to a single tertiary care center between January 2012 to July 2017 for TOLAC after one cesarean delivery. Women with eLGA were compared to women with EFW < 90th percentile. Inclusion criteria included singleton pregnancy, gestational age ≥37 weeks. Women with multiple gestation, a history of ≥2 Cesarean deliveries, non-vertex presentation, intrauterine fetal demise or maternal contra indication for vaginal delivery were excluded. Primary outcome was defined as successful vaginal birth after cesarean (VBAC).
Ultrasonographic fetal weight evaluations were performed at admission as part of routine care. Estimation of fetal weight was calculated using the Hadlock equation. Large estimation of fetal weight was defined as a fetal weight above the 90th percentile using the ”Dolberg curves” for Israeli population (10).
Our center’s policy is to offer TOLAC to every woman with a history of one Cesarean delivery taking into consideration her specific risks for adverse outcome.
Primary outcome was defined as the rate of successful VBAC, secondary outcomes included adverse obstetrical outcomes (scar dehiscence or uterine rupture, 3rd /4th degree perineal tear, shoulder dystocia, postpartum hemorrhage, and a need for blood transfusion). Data were collected from computerized medical records and included demographic characteristics, obstetric and medical history, delivery maternal and neonatal outcomes and early post-partum course.