# Risks and Probabilities of Adverse Pregnancy Outcomes in Patients Undergoing Trial of Labor after Cesarean—A Retrospective Study

## TL;DR

This study examines the risks of complications during trial of labor after cesarean in Romanian hospitals, finding higher risks for both mothers and babies when the trial fails.

## Contribution

The study provides new risk probabilities for maternal and neonatal complications associated with failed TOLAC in a Romanian context.

## Key findings

- Failed TOLAC increases risks of uterine rupture, ICU admission, and emergency hysterectomy for mothers.
- Newborns of mothers with failed TOLAC face higher risks of low Apgar scores, NICU admission, and invasive ventilation.
- The study emphasizes the need for tertiary care monitoring during TOLAC attempts.

## Abstract

(1) Background: Trial of labor after cesarean (TOLAC) can be associated with significant maternal and neonatal complications, and the aim of this retrospective study was to calculate the risks and probabilities of these complications in two tertiary maternity centers in Romania. (2) Methods: A total of 216 patients who attempted TOLAC were included in the study and were segregated into two groups, depending on TOLAC success. Medical records were assessed, and clinical data were used to determine the maternal and neonatal risks and complications, using multinomial logistic regression and postestimation predictions. (3) Results: Our data indicated that patients who had a failed TOLAC had significantly higher risks and probabilities of uterine rupture, either complete or incomplete; intensive care unit (ICU) admission; and emergency hysterectomy. The newborns of these mothers had significantly higher risks and probabilities of low Apgar score at birth, neonatal intensive care unit (NICU) admission, and invasive ventilation. (4) Conclusions: Failed TOLAC could lead to significant maternal and neonatal complications, and women who attempt this procedure should be monitored in a tertiary center where a multidisciplinary team and an emergency operating room are available.