Material and Methods
A retrospective cohort study including all women admitted to a single
tertiary care center between January 2012 to July 2017 for TOLAC after
one cesarean delivery. Women with eLGA were compared to women with EFW
< 90th percentile. Inclusion criteria
included singleton pregnancy, gestational age ≥37 weeks. Women with
multiple gestation, a history of ≥2 Cesarean deliveries, non-vertex
presentation, intrauterine fetal demise or maternal contra indication
for vaginal delivery were excluded. Primary outcome was defined as
successful vaginal birth after cesarean (VBAC).
Ultrasonographic fetal weight evaluations were performed at admission as
part of routine care. Estimation of fetal weight was calculated using
the Hadlock equation. Large estimation of fetal weight was defined as a
fetal weight above the 90th percentile using the ”Dolberg curves” for
Israeli population (10).
Our center’s policy is to offer TOLAC to every woman with a history of
one Cesarean delivery taking into consideration her specific risks for
adverse outcome.
Primary outcome was defined as the rate of successful VBAC, secondary
outcomes included adverse obstetrical outcomes (scar dehiscence or
uterine rupture, 3rd /4th degree
perineal tear, shoulder dystocia, postpartum hemorrhage, and a need for
blood transfusion). Data were collected from computerized medical
records and included demographic characteristics, obstetric and medical
history, delivery maternal and neonatal outcomes and early post-partum
course.