European journal of obstetrics, gynecology, and reproductive biology · 2026
Isolating the effect of prior cesarean delivery on operative vaginal delivery in subsequent labor among women with prior vaginal birth: A matched cohort study.
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Bor Nati, Accav Noa Golan, Krissi Matan, Gomez-Tolub Rachel, Matot Ran, Barbash-Hazan Shiri, Hadar Eran, Shmueli Anat
Аннотация
OBJECTIVE: TOLAC (trial of labor after cesarean) is associated with higher rates of operative vaginal delivery (OVD) compared with deliveries without a prior cesarean. However, it remains unclear whether this reflects the independent effect of prior cesarean delivery or differences in pelvic characteristics and labor dynamics. We aimed to isolate the association between prior cesarean delivery and OVD risk while minimizing confounding related to parity and previous vaginal births.
DESIGN: Retrospective matched cohort study.
SETTING: Single university-affiliated tertiary center.
POPULATION: Multiparous patients who attempted a first TOLAC between January 2013 and December 2023.
METHODS: Patients attempting their first TOLAC with at least one prior vaginal delivery were compared with parity-matched multiparous patients without a prior cesarean delivery. Multivariable logistic regression was used to assess the independent association between TOLAC and OVD after adjustment for maternal age, body mass index, height, smoking status, gestational diabetes, chronic hypertension, and other chronic diseases.
MAIN OUTCOME MEASURES: The primary outcome was the rate of OVD. Secondary outcomes included indications for OVD and the association between parity and OVD risk.
RESULTS: The cohort included 639 TOLAC patients and 43,665 controls. OVD rates were higher among TOLAC patients than parity-matched controls (7.5 % vs. 2.73 %, p < 0.001) and remained significant after additional adjustment for other chronic diseases (aOR 3.26, 95 % CI 2.15-4.93, p < 0.001). Increased risk was observed among women with one or two prior vaginal deliveries but not among those with ≥ 3 prior vaginal deliveries.
CONCLUSIONS: Prior cesarean delivery independently increases OVD risk during TOLAC; however, this excess risk is not observed among women with ≥ 3 prior vaginal deliveries, highlighting the modifying role of obstetric history.
DESIGN: Retrospective matched cohort study.
SETTING: Single university-affiliated tertiary center.
POPULATION: Multiparous patients who attempted a first TOLAC between January 2013 and December 2023.
METHODS: Patients attempting their first TOLAC with at least one prior vaginal delivery were compared with parity-matched multiparous patients without a prior cesarean delivery. Multivariable logistic regression was used to assess the independent association between TOLAC and OVD after adjustment for maternal age, body mass index, height, smoking status, gestational diabetes, chronic hypertension, and other chronic diseases.
MAIN OUTCOME MEASURES: The primary outcome was the rate of OVD. Secondary outcomes included indications for OVD and the association between parity and OVD risk.
RESULTS: The cohort included 639 TOLAC patients and 43,665 controls. OVD rates were higher among TOLAC patients than parity-matched controls (7.5 % vs. 2.73 %, p < 0.001) and remained significant after additional adjustment for other chronic diseases (aOR 3.26, 95 % CI 2.15-4.93, p < 0.001). Increased risk was observed among women with one or two prior vaginal deliveries but not among those with ≥ 3 prior vaginal deliveries.
CONCLUSIONS: Prior cesarean delivery independently increases OVD risk during TOLAC; however, this excess risk is not observed among women with ≥ 3 prior vaginal deliveries, highlighting the modifying role of obstetric history.