Trial of labor after cesarean delivery in grand multiparous women: maternal and neonatal outcomes

Objective: To evaluate success rates of vaginal birth after cesarean (VBAC) and maternal and neonatal outcomes associated with trial of labor after cesarean in grand multiparous women. Study design: A retrospective computerized data base study was conducted at a single tertiary center, between 2005 and 2019. The study compared the maternal and neonatal outcomes of trial of labor after cesarean delivery in grand multiparous women (parity ≥ 6) as compared to multiparous women (parity: 3–5). Comparison analysis was performed by univariate analysis and followed by adjusted multiple logistic regression models. Results: During the study period we identified 2749 and 4294 cases of trial of labor after cesarean in grand multiparous and multiparas, respectively. VBAC was observed in 94.6% of the grand multiparous as compared to 96.5% in the multiparous group, p <.01. The grand multiparous group had a higher rate of postpartum hemorrhage (3 vs. 2.2%, p =.03) and prolonged postpartum hospitalization (1.4 vs. 0.7%, p <.01). The rates of uterine rupture (0.3 vs. 0.2%, p=.50), peripartum hysterectomy (0.1 vs. 0%, p =.33) and adverse neonatal outcomes were comparable between the groups. Conclusion: Trial of labor after cesarean in grand multiparous women is associated with favorable maternal and neonatal outcomes. Consideration and awareness should be given for the increased risk for postpartum hemorrhage, not associated with uterine rupture.