Two Previous Cesarean and Vaginal Birth Before and After Starting Training and Protocols
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- The protocol lists: Acceptance, rate of vaginal birth and safety.
- Who it may be relevant to
- Registry conditions: Cesarean Delivery Affecting Fetus or Newborn, Labor (Obstetrics)--Complications, Hemorrhagic Complications. Basic parameters: from 18 years · Female.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- Italy
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
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Official title
Trial of Labor After Two CS Before and After Training a Protocol Introduction
Overview
In 2015 ObGyn Dept of Santo Spirito Hospital in Pescara (Italy) started protocol for previous CS vaginal birth. In 2021 was started a protocol for training on obstetric emergencies and protocol on two previous cesarean was endorsed. Patients attending birth in Pescara with two previous from january 2016 to December 2020, and from january 2021 to december 2025 were collected. A different counseling approach was adopted from 2021. Women's acceptance of trial of labor and maternal and fetal outcomes were collected.
Detailed description
Women attending birth in Santo Spirito Hospital with 2 previous CS were collected.
Exclusion Criteria:
* Patients with clinical indication to CS * a previous CS less than 18 month before * breech presentations * triplets * premature labor before 34 completed weeks' gestation The first period was starting January 1st 2016 to December 31st 2020. The second period was starting January 1st 2021 to December 31st 2025
Primary outcomes:
* incidence of trial of labor acceptance * incidence of vaginal birth
Secondary outcomes:
* maternal adverse outcomes (PPH, blood transfusion, vaginal tears, hysterectomy, maternal death) * fetal adverse outcomes (fetal death, NICU stay, APGAR score less than 7 at 5')
Interventions
- Procedure Acceptance, rate of vaginal birth and safety
In 2021 started a new delivery protocol enhancing the opportunity of having a trial of labor in women with a history of two previous CS. Rate of acceptance, rate of successful vaginal birth, maternal and fetal outcomes were evaluated
Primary outcome measures
- vaginal birth after 2 cesarean [Time frame: 5 years]
- accepted indication to trial of labor [Time frame: 5 years]
Secondary outcome measures (3)
- emergency CS [Time frame: 5 years]
- maternal outcomes [Time frame: 5 years]
- Fetal and Neonatal adverse outcomes [Time frame: 5 years]
Eligibility criteria
Inclusion criteria
- pregnant women
- pregnancy above 34 weeks' gestation
- cephalic presentation of the fetus
- singleton and twins
- diamniotic twins
- 2 previous CS
- more than 18 months from last CS
- no other indication to CS
Exclusion criteria
- pregnancy below 34 weeks' gestation
- breech baby
- triplets or high order multiple pregnancies
- more than 2 previous CS
- less than 18 months from last CS
- precence of other indications to CS (i.e. maternal diseases, placenta previa, etc.)
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: No
Study design
- Observational model
- Cohort
Study locations
Italy · 2 centers
- Claudio Celentano — Pescara
- Santo Spirito Hospital — Pescara
Publications
- Brandstetter M, Brandstetter A, Kainz-Schultes S, Jacobs VR, Fazelnia C, Fischer T, Bogner G. Successful Trial of Labor After Two Caesarean Sections (TOLA2C): Analysis of a Delivery Protocol with Feto-Maternal Outcome. Geburtshilfe Frauenheilkd. 2025 Feb 7;85(8):862-869. doi: 10.1055/a-2513-6562. eCollection 2025 Aug. PMID 40771829
Identifiers
NCT: NCT07258459 · ObGynEASC009