title: Trial of labor after cesarean versus repeat cesarean in women with small-for-gestational age neonates: a secondary analysis.
abstract: OBJECTIVE
  The objective of this study was to determine whether trial of labor after cesarean (TOLAC) is associated with increased risk of adverse outcomes for small-for-gestational-age (SGA) neonates.
  
  
  METHODS
  This secondary analysis of a multicenter prospective observational study evaluated SGA neonates born to women with a single prior cesarean delivery. Nonanomalous, singleton pregnancies delivered at 24-41 weeks were included. The primary exposure was whether women underwent planned cesarean versus attempted TOLAC. Log-linear regression models were developed to characterize the relationship between TOLAC and neonatal outcomes. The primary outcome was a composite measure of neonatal morbidity and/or mortality, including death, respiratory complications, treated hypoglycemia, sepsis, neonatal intensive care unit (NICU) admission and hospital stay >5 days.
  
  
  RESULTS
  Of 1009 patients identified, 258 underwent repeat cesarean; 751 attempted TOLAC. Controlling for age, race, body mass index, smoking, maternal disease, prior vaginal birth after cesarean, corticosteroids, prematurity and nonreassuring fetal status as indication for delivery, the composite adverse outcome was similarly likely in both groups (adjusted risk ratio (RR) 0.99, 95% confidence interval (95% CI) 0.88-1.12, p = 0.93).
  
  
  CONCLUSIONS
  SGA infants born to women who TOLAC have similar neonatal outcomes to those who deliver by planned repeat cesarean. We conclude that TOLAC is an acceptable option for women with a prior cesarean and suspected SGA neonates.
authors.affiliation: a Division of Maternal-Fetal Medicine , Department of Obstetrics and Gynecology, Columbia University Medical Center , New York , NY , USA.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Turitz
authors.affiliation: a Division of Maternal-Fetal Medicine , Department of Obstetrics and Gynecology, Columbia University Medical Center , New York , NY , USA.
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Friedman
authors.affiliation: a Division of Maternal-Fetal Medicine , Department of Obstetrics and Gynecology, Columbia University Medical Center , New York , NY , USA.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Gyamfi-Bannerman
mesh_terms: D000328:Adult; D017604:Cesarean Section, Repeat / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D011247:Pregnancy; D011256:Pregnancy Outcome; D012307:Risk Factors; D014219:Trial of Labor; D016064:Vaginal Birth after Cesarean / Q000009:adverse effects / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Growth restriction; mode of delivery; vaginal birth after cesarean