Poster Session III
org
CD¼>1 n¼15. Statistical analysis was performed using T-Test
Assuming Unequal Variance.
RESULTS: The results obtained for the different contractile parame-
ters, for the 3 groups, are shown in Table 1. 592 tissue samples were
analysed from 74 women. The only significant difference (Table 2) in
contractile parameters found was in the frequency of contractions,
with a lower frequency of contractions in the CD¼1 group
compared to CD¼0 and CD¼>1 groups (p¼6.36E-06 and
p¼0.000135 respectively).
CONCLUSION: These data indicate that there is no significant differ-
ence in the general biological characteristics of human uterine
contractions in vitro, in women who have had one, or greater that
one previous CD, in comparison to women who have had none. The
only notable feature is that the frequency of contractions was greater
in the sub-group of women who had one previous CD. These
findings indicate that factors other than the functional contractility
of uterine tissue, may be responsible for the increased CD rate
observed among women undergoing VBAC.References 1. Crank-
shaw DJ, O’Brien YM, Crosby DA, Morrison JJ. Maternal Age and
Contractility of Human Myometrium in Pregnancy. Reprod Sci.
2015 Oct;22(10)
S350 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2018
ajog.
585 Trial of labor after cesarean (TOLAC) in women
with Premature rapture of membranes
Michal Fishel Bartal1, Baha Sibai2, Hadas Ilan1, Moran Frid1,
Roni Rahav1, Heli Alexandroni1, Avi Shina1, Irit Eisen1,
Israel Hendler1
1
Tel Hashomer, Tel aviv, Israel, 2University of Texas Health Science Center at
Houston, Houston, TX
OBJECTIVE: Reducing the rate of cesarean section by increase in the
rate of TOLAC is important to address since repeat cesarean section
is associated with increased maternal morbidity and mortality. There
is limited data regarding risks and benefits of TOLAC after prema-
ture rapture of membranes (PROM). We investigated the success rate
of TOLAC after PROM between those receiving conservative man-
agement and those receiving labor induction.
STUDY DESIGN: This was a retrospective cohort study conducted in a
single tertiary care center between 01/2011-03/2017. All women with
singleton pregnancy and a previous cesarean section who presented
with PROM after 34 0/7 weeks of gestation and underwent TOLAC
were included. To minimize labor induction, women were offered
conservative management until spontaneous labor commenced.
Labor induction was performed if spontaneous onset of labor did
not take place within 48 hours or if there were signs of maternal or
fetal distress. Operative complications were defined as: laceration of
the uterus, bladder injury, urethral injury, bowel injury or hyster-
ectomy. Postpartum complications were defined as: fever, endome-
tritis, need for blood transfusion and wound complications.
Outcomes and rate of successful vaginal delivery after induction of
labor were compared to spontaneous onset of labor using uni-
variable and multivariable analysis.
RESULTS: Among 830 women who met the inclusion criteria, 723
(87.1%) had a spontaneous delivery and 107 (12.9%) had an in-
duction of labor. The rate of successful TOLAC was similar between
the groups (75.7% vs 81.6%, respectively, P¼0.22). However, in-
duction of labor was associated with an increased risk of uterine
rupture (1.87% vs 0.96%, P <0.001), operative complications
(30.76% vs 12.03%, P<0.001) and composite maternal postpartum
complications (21.4% vs 12.1%, respectively, P¼ 0.014) compared to
spontaneous vaginal delivery. There was no difference in neonatal
outcome between the groups.
CONCLUSION: In women attempting TOLAC who present with PROM
and fail to progress spontaneously into active labor, Induction of
labor is associated with high successful vaginal delivery rate. How-
ever, the risk for uterine rupture and operative and maternal com-
plications is significantly increased compared to spontaneous
delivery.
586 Do the “right” candidates for vaginal birth after
cesarean delivery choose a trial of labor?
Jennifer A. Braverman, Emily K. Redman, Francesca L. Facco,
Katherine P. Himes
Magee-Womens Research Institute, University of Pittsburgh School of
Medicine, Dept of OB/GYN/RS, Division of MFM, Pittsburgh, PA
OBJECTIVE: The Maternal Fetal Medicine Units Network (MFMU)
vaginal birth after cesarean delivery (VBAC) predictive model is
widely used to inform counseling. We sought to evaluate the asso-
ciation between predicted chance of successful VBAC and attempted
trial of labor after cesarean (TOLAC) and to identify other factors
associated with TOLAC.
STUDY DESIGN: This is a single-center retrospective cohort study of
term singleton births in 2010 to women with one prior cesarean.
Women with contraindications to VBAC or missing data to calculate