Trial of labor after cesarean: attempted operative vaginal delivery versus emergency repeat cesarean, a prospective national cohort study

Objective:To compare neonatal and maternal outcomes of attempted operative vaginal delivery with emergency repeat cesarean in trial of labor after cesarean.Study design:Prospective 8-year cohort analysis using the Netherlands Perinatal Registry, including women with one prior cesarean giving birth through operative vaginal delivery or emergency repeat cesarean (n=12860). A multivariate analysis was performed. Odds ratios (OR) and adjusted odds ratios (aOR) were calculated.Results:Attempted operative vaginal delivery increases the risk on neonatal birth trauma (aOR 15.0 (5.94 to 38.0)) and postpartum hemorrhage (aOR 2.59 (2.17 to 3.09)), and lowers the risk of wet lung syndrome (aOR 0.53 (0.35 to 0.80)) and neonatal convulsions (aOR 0.47 (0.24 to 0.91)).Conclusion:We found a highly increased risk of neonatal birth trauma and a moderately increased risk of postpartum hemorrhage but slightly lower risks of wet lung syndrome and neonatal convulsions after attempted operative vaginal delivery compared with emergency repeat cesarean.