Trial of Labor vs. Repeat Cesarean Delivery in Individuals with Morbid Obesity After Previous Cesarean Delivery.

To compare adverse neonatal outcomes associated with the trial of labor after cesarean section (TOLAC) at term in pregnancies according to maternal prepregnancy body mass index (BMI kg/m2) and the presence of previous vaginal delivery (VD). This was a repeated cross-sectional analysis of individuals with singleton, cephalic, and term deliveries with a history of one or two cesarean deliveries in the Linked Birth/Infant Death data from 2011 to 2020. Outcomes were examined according to the BMI category including BMI <30, 30-39.9, and 40-69.9 kg/m2. The primary outcome was a composite neonatal outcome, defined as any presence of neonatal death, neonatal intensive care unit admission, assisted ventilation, surfactant therapy, or seizures. Outcomes were compared between TOLAC and elective repeat cesarean delivery (eRCD) after stratifying by BMI category and previous VD. Log-binomial regression was performed to obtain adjusted relative risk (aRR) with 99% confidence intervals (99%CI), controlling for covariates. Of 4,055,440 individuals, 2,627,131 had BMI<30, 1,108,278 had BMI 30-39.9, and 320,031 had BMI 40-69.9. In individuals with no previous VD, VD rates after TOLAC were 66.7%, 57.2%, and 48.1%, respectively. In individuals with previous VD, VD rates after TOLAC were 81.4%, 74.7%, and 67.3%, respectively. In individuals without previous VD, compared to those who had an eRCD, those who had TOLAC were more likely to experience composite neonatal outcomes in individuals with BMI <30 (5.0% vs. 6.5%; aRR 1.33 [1.30 1.36]), BMI 30-39.9 (6.1% vs. 7.8%; aRR 1.29 [1.24-1.34]), and BMI 40-69.9 (8.2% vs. 9.0%; aRR 1.15 [1.07-1.23]). In individuals with previous VD, there was no difference in the composite neonatal outcomes in BMI <30 (6.2% vs.5.8%; aRR 0.98 [0.96-1.00]), BMI 30-39.9 (7.4% vs.7.1%; aRR 0.99 [0.95-1.02]), and BMI 40-69.9 (9.4% vs. 8.7%; aRR 0.96 [0.91-1.02]). TOLAC among obese individuals could be offered in selected cases.

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The authors declare that they have no conflict of interest.