1Department of Obstetrics and Gynecology, Sheba
Medical Center, Ramat Gan, Israel, 2Sackler School of
Medicine, Tel Aviv University, Tel Aviv, Israel
Correspondence: Or Bercovich, Bsc, Sackler School of Medicine,
Tel Aviv University, Tel Aviv, Israel 69978. Tel: 972-526-316386. Fax:
972-3-5616663. E-mail: orbercovich@mail.tau.ac.il
Short Title: TOLAC for estimated LGA
Abstract:Objective: Estimated fetal weight, large for gestational age
(eLGA) (≥90th percentile) may be associated with
failed trial of labor after Cesarean (TOLAC), like fetal macrosomia. The
aim of this study was to evaluate obstetrical outcome and safety of
TOLAC, for women with eLGA.
Design: A retrospective cohort study.
Setting: a single large tertiary care center.
Population or Sample: all women with singleton pregnancy,
gestational age ≥ 37weeks, admitted for TOLAC between 2012 and 2017.
Methods: Women with eLGA were compared to women with EFW
< 90th percentile.
Main outcome measures: the rate of successful vaginal delivery,
adverse obstetrical outcomes.
Results: 1949 women met inclusion criteria, including78 (4%)
eLGA and 1871 (96%) controls. Study group were older (35 vs. 33 year;
p=0.004), with higher Body Mass Index (30.9 vs. 27.5
kg/m2; p=0.001) and higher gravidity (4 vs. 3;
p=0.001) compared to the controls. Median fetal weight was [3887g (IQR
3718-4073) vs. 3275g (IQR 2995-3545); p=0.001 in the study vs. controls
respectively]. 55 (70.5%) women in the study group had successful
vaginal delivery compared to 1506 (80.5%) women in the control (p=
0.03). The rate of obstetrical complications, including: scar
dehiscence, uterine rupture, 3rd/4th degree perineal tear or shoulder dystocia were
comparable. The rate of post-partum hemorrhage was increased in the
study group compared to controls (7.7% vs.1.7%; p=0.001).
Conclusion: TOLAC for eLGA fetuses can be considered as safe,
however, lower successful VBAC rates and increased PPH rate may be
expected.
Funding : The authors received no specific funding for this
work.
key words: Trial of labor after Cesarean delivery, Vaginal
birth after Cesarean delivery, large for gestational age, uterine
rupture, repeat Cesarean delivery.