Successful Trial of Labour after two Caesarean Sections (TOLA2C): Analysis of a delivery protocol with feto-maternal outcome

Objective: : This study aimed to establish a delivery protocol for safely undergoing trial of labour after two Caesarean Sections and analysed predictors for a successful vaginal delivery. Design: : Retrospective cohort study Setting: : Single centre tertiary community hospital Population : Between the study period 385 women planned a delivery after two consecutive Caesarean Sections. According to defined prepartum criteria of the delivery protocol, 358 patients (93.0%) were scheduled as primary third Caesarean Section, while 27 (7.0%) for attempting vaginal delivery. Methods: : Those women, who desired TOLA2C, were screened by a senior obstetrician and had to consent to a delivery protocol consisting of five pre- and eight peripartal criteria. Maternal demographic data, indications for previous CS and feto-maternal outcome parameters were compared between the successful TOLA2C group and the secondary Third-Caesarean section group. Main Outcome Measures: The primary outcome was the success rate of women undergoing TOLA2C who fulfilled the predefined protocol. Additionally maternal demographic data, indications for previous CS and feto-maternal outcome parameters were compared between the successful TOLA2C group and the abandoned TOLA2C group. Results: : In the study period, n =385 women planned a delivery after two consecutive CS. Following the protocol, n= 358 patients (93.0%) were scheduled as primary Re-Re-CS, while n=27 (7.0%) attempted vaginal delivery. In this TOLA2C group, n=17 women (63.0%) successfully delivered vaginally. In contrast, n=10 failed vaginal attempts (37.0%) resulted in nine secondary Re-Re-CS and one in a secondary Re-Re Emergency CS. Women with prior vaginal delivery had a significantly higher chance of a successful TOLA2C (p=0.04). In comparison, women with a previous CS due to the indication of arrested labor had a significantly higher risk for a secondary Re-Re-CS (p=0.02). No fetal or maternal death occurred, and no major complications were observed. Conclusions: : Under the specified conditions, TOLA2C is safe for mother and fetus, and successful vaginal delivery is feasible.