Trial of Labor After Cesarean (TOLAC)

Maternal and Perinatal Mortality Rates

• Maternal and perinatal mortality rates are generally lower for elective repeat cesarean births compared to Trial of Labor after Cesarean (TOLAC).
• Increased risk factors for maternal complications associated with TOLAC can include uterine rupture and hemorrhage.

Success Rate of TOLAC

• The success rate of TOLAC is approximately 60-80%, indicating a significant likelihood of vaginal delivery after a cesarean.

Timing for Cesarean Section

• A cesarean section is recommended when suspected maturity indicates potential risks to the mother or fetus, such as poor fetal growth or distress.

Planning Delivery After Nonrecurring Indication

• If the previous cesarean was performed for a nonrecurrent indication with a sound uterine scar, a trial of labor (vaginal delivery) can often be planned.

Management of Labor and Delivery for TOLAC

• Continuous electronic fetal monitoring is essential to assess fetal well-being during labor and delivery for TOLAC.
• An emergency cesarean section should be readily available in case of complications.

Induction Recommendations for TOLAC

• Induction of labor for TOLAC should be approached cautiously; if necessary, methods like cervical ripening agents can be used, but certain agents like prostaglandins should be avoided due to increased risks.

Analgesia Recommendations for TOLAC

• It is advisable to utilize regional analgesia, such as epidurals, for pain management during labor and delivery in TOLAC cases to facilitate optimal care and monitoring.

Monitoring Fetal Behavior During Labor for TOLAC

• Fetal behavior is closely monitored through continuous fetal heart rate monitoring to detect any signs of distress or complications that may arise during labor.