Trial of labor following cesarean among patients with oligohydramnios at term: A multicenter retrospective study

The aim of this study was to evaluate the maternal and neonatal outcomes of patients with oligohydramnios attempting a trial of labor after cesarean (TOLAC) versus those who underwent planned repeat cesarean delivery (PRCD).

We conducted a multicenter retrospective cohort study of patients with a term singleton pregnancy following a single low-segment transverse cesarean delivery (CD) and a recent diagnosis of oligohydramnios (maximal vertical pocket <2 cm) between 2017 and 2021. Maternal and neonatal outcomes were compared between patients attempting TOLAC and those opting for PRCD. Univariate analysis was conducted, followed by a multivariate analysis.

A total of 352 deliveries were included, of which 278 (79%) attempted TOLAC and 74 (21%) attempted PRCD. The successful vaginal delivery rate for patients who attempted TOLAC was 84.5%. The uterine rupture rate was not significantly different between those attempted TOLAC versus PRCD (1.1% vs. 0%, P = 0.371). However, the rate of hypoglycemia (2.2% vs. 8.1%, P = 0.012) and the composite adverse neonatal outcome was higher among patients with PRCD (11.5% vs. 24.3%, P = 0.005). After controlling for potential confounders, we still demonstrated an independent association between reduced rates of composite adverse neonatal outcome and TOLAC (adjusted odds ratio 0.46, 95% CI: 0.23-0.92, P = 0.028).

TOLAC for patients with oligohydramnios appears to be a reasonable alternative and is associated with favorable outcomes. Further large and prospective research on this subject may lead to improved management strategies and better maternal and neonatal outcomes.