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Trial of labor after cesarean delivery (TOLAC) in Japan: rates and complications

  • Maternal-Fetal Medicine
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Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To determine the rates of trial of labor after cesarean delivery (TOLAC) and complications in Japan.

Methods

We conducted a descriptive study of pregnant women with one prior cesarean section registered between January 2013 and December 2015 in the perinatal database of the Japan Society of Obstetrics and Gynecology. This database is a nationwide institution-based registry in Japan. This study included women who had undergone one prior cesarean delivery and who delivered a singleton by cephalic presentation between 37 and 41 weeks of gestation. We collected data on delivery method, particularly with regard to the involvement of TOLAC or elective repeated cesarean deliveries (ERCD). Rates of TOLAC were investigated by facility type, and we calculated the rates of maternal and perinatal complications including uterine rupture in TOLAC.

Results

During the study period, 647,098 births were registered. Among the 34,460 women who met the inclusion criteria, 1730 (5.0%) and 32,730 (95.0%) underwent TOLAC and ERCD, respectively. In total, 76.4% of hospitals did not perform TOLAC at all. Generally in perinatal medical centers, which are better equipped with facilities, 58.7% women did not perform TOLAC. With regard to complications, we identified eight cases (0.46%) of uterine rupture with TOLAC. TOLAC births did not include maternal death and perinatal death. Among women attempting TOLAC, 1532 (88.6%) had successful vaginal births.

Conclusion

The TOLAC rate in Japan was considerably lower than that reported in other countries, despite comparable complication rates.

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References

  1. Vogel JP, Betrán AP, Vindevoghel N, Souza JP, Torloni MR, Zhang J et al (2015) on behalf of the WHO Multi-Country Survey on Maternal and Newborn Health Research Network. Use of the robson classification to assess caesarean section trends in 21 countries: a secondary analysis of two WHO multicountry surveys. Lancet Glob Health 3:e260–e270

    Article  Google Scholar 

  2. Ye J, Betran AP, Vela MG, Souza JP, Zhang J (2014) Searching for the optimal rate of medically necessary cesarean delivery. Birth 41:237–243

    Article  Google Scholar 

  3. Boatin AA, Schlotheuber A, Betran AP, Moller AB, Barros AJD, Boerma T et al (2018) Within country inequalities in caesarean section rates: observational study of 72 low and middleincome countries. BMJ 24(360):k55

    Article  Google Scholar 

  4. Betrán AP, Ye J, Moller AB, Zhang J, Gülmezoglu AM, Torloni MR (2016) The increasing trend in caesarean section rates: global, regional and national estimates: 1990–2014. PLoS ONE 5(11):e0148343

    Article  Google Scholar 

  5. World Health Organization Human Reproduction Programme (2015) WHO statement on caesarean section rates. Reprod Health Matters 2015(23):149–150

    Google Scholar 

  6. Timofeev J, Reddy UM, Huang C-C, Driggers RW, Landy HJ, Laughon SK (2013) Obstetric complications, neonatal morbidity, and indications for cesarean delivery by maternal age. Obstet Gynecol 122:1184–1195

    Article  Google Scholar 

  7. Brennan D, Murphy M, Robson M, O'Herlihy C (2011) The singleton, cephalic, nulliparous woman after 36 weeks of gestation—contribution to the overall cesarean delivery rates. Obstet Gynecol 117:273–279

    Article  Google Scholar 

  8. Roberts C, Algert C, Ford J, Todd A, Morris J (2012) Pathways to a rising caesarean section rate: a population-based cohort study. BMJ Open 2:e001725

    Article  Google Scholar 

  9. Guise JM et al (2010) Vaginal birth after cesarean: new insights on maternal and neonatal outcomes. Obstet Gynecol 115:1267–1278

    Article  Google Scholar 

  10. Cunningham FG et al (2001) Williams Obstetrics, 24th edn. McGraw-Hill, New York

    Google Scholar 

  11. National Institutes of Health (2010) National Institutes of Health Consensus Development Conference Statement vaginal birth after cesarean: new insights March 8–10, 2010. Semin Perinatol 34:351–365

    Article  Google Scholar 

  12. Curtin SC et al (2015) Maternal morbidity for vaginal and cesarean deliveries, according to previous cesarean history: new data from the birth certificate, 2013. Natl Vital Stat Rep 64:1–13

    PubMed  Google Scholar 

  13. Ministry of Health, Labor and Welfare. NDB open data Japan. https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/0000177182.html. Accessed 5 Apr 2019

  14. Ministry of Health, Labor and Welfare. Vital statistics. https://www.mhlw.go.jp/toukei/list/81-1a.html. Accessed 5 Apr 2019

  15. Maeda E, Ishihara O, Tomio J, Sato A, Terada Y, Kobayashi Y et al (2018) Cesarean section rates and local resources for perinatal care in Japan: a nationwide ecological study using the national database of health insurance claims. J Obstet Gynaecol Res 44:208–216

    Article  Google Scholar 

  16. Japan Society of Obstetrics and Gynecology (2017) Guideline for Obstetrical Practice in Japan 2017, 4th edn. KANEHARA & CO., LTD, Tokyo

    Google Scholar 

  17. American College of Obstetricians and Gynecologists. ACOG (2017) Practice bulletin no. 184: Vaginal birth after cesarean delivery. Obstet Gynecol 130:e217–e233

    Google Scholar 

  18. Royal College of Obstetricians and Gynaecologists Birth After Previous Caesarean Birth. RCOG Green-top Guideline. No. 45. https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_45.pdf. Accessed 5 Apr 2019

  19. Hill JB, Ammons A, Chauhan SP (2012) Vaginal birth after cesarean delivery: comparison of ACOG practice bulletin with other national guidelines. Clin Obstet Gynecol 55:969–977

    Article  Google Scholar 

  20. Shiozaki A, Matsuda Y, Hayashi K, Satoh S, Saito S (2011) Comparison of risk factors for major obstetric complications between Western countries and Japan: a case-cohort study. J Obstet Gynaecol Res 37:1447–1454

    Article  Google Scholar 

  21. Morisaki N, Nagata C, Jwa SC, Sago H, Saito S, Oken E, Fujiwara T (2017) Pre-pregnancy BMI-specific optimal gestational weight gain for women in Japan. J Epidemiol 27:492–498

    Article  Google Scholar 

  22. Japan Society of Obstetrics and Gynecology (2017) Perinatal Committee Report ACTA Obstetrica et Gynaecologyca Japonica 69:1445–1479. https://www.mhlw.go.jp/toukei/saikin/hw/iryosd/15/dl/02_01.pdf. Accessed 5 Apr 2019

  23. Ministry of Health, Labor and Welfare. The guidance to perinatal medical system construction [cited 2017 July 31]. https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/0000186912.html. Accessed 5 Apr 2019

  24. Nilsson C, Lalor J, Begley C, Carroll M, Gross MM, Grylka-Baeschlin S et al (2017) Vaginal birth after caesarean: views of women from countries with low VBAC rates. Women Birth 30:481–490

    Article  Google Scholar 

  25. Hakozaki Y, Torigoe I, Sato k (2017) Investigating the relationship between maternal satisfaction with the cesarean birth experience and early postpartum depressive tendencies—verifying the reliability and validity of the Japanese version of the SMMS. J Jpn Acad Midwif 31(2):140–152

    Article  Google Scholar 

  26. Landon MB et al (2006) Risk of uterine rupture with a trial of labor in women with multiple and single prior cesarean delivery. Obstet Gynecol 108:12–20

    Article  Google Scholar 

  27. Lydon-Rochelle M et al (2001) Risk of uterine rupture during labor among women with a prior cesarean delivery. N Engl J Med 345(1):3–8

    Article  CAS  Google Scholar 

  28. Macones GA et al (2005) Maternal complications with vaginal birth after cesarean delivery: a multicenter study. Am J Obstet Gynecol 193(5):1656–1662

    Article  Google Scholar 

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Acknowledgements

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Funding

The authors did not receive any funding for this study.

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Authors and Affiliations

Authors

Contributions

AT: protocol and project development, data collection, data analysis, manuscript writing. EA: protocol and project development, data analysis, manuscript editing. YT: protocol and project development, data analysis, manuscript editing. EK: data analysis, manuscript editing, other (interpretation of data). MM: data analysis, manuscript editing, other (interpretation of data). TN: protocol and project development, data analysis, manuscript editing.

Corresponding author

Correspondence to Aya Takeya.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Takeya, A., Adachi, E., Takahashi, Y. et al. Trial of labor after cesarean delivery (TOLAC) in Japan: rates and complications. Arch Gynecol Obstet 301, 995–1001 (2020). https://doi.org/10.1007/s00404-020-05492-8

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  • DOI: https://doi.org/10.1007/s00404-020-05492-8

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