Berks County Medical Society Medical Record Fall 2018 - 23

2.1-22.5). Between failed and successful TOLAC groups, there was
no statistically significant difference in gestational age, maternal age,
BMI, history of prior vaginal delivery, initial cervical dilatation and
effacement, epidural placement, diabetic, birth weight, or NICU
admission. However, a significantly higher number of patients were
induced in failed group (8[80%] vs. 13[42%], p=0.036, Chi-square
test).

CONCLUSIONS:
Labor progresses slowly before cervical dilation reaches 5 cm,
and it may take as long as 17 hours from 3 to 5 cm. As long as fetal
wellbeing is reassuring, we may consider allowing TOLAC patients
to labor for longer than we usually thought before active labor begins
(newly defined as 5cm, regardless of effacement). Labor progress
accelerates after cervical dilation reaches 7 cm. The study showed
it takes about 2 hours (mean duration) to dilate from 7 cm to 10
cm with the longest duration being 4.5 hrs. The traditional 2-hour
rule for diagnosing arrest of dilatation (meaning it would take 6
hours to dilate from 7-10 cm) may not apply after cervical dilatation
reaches 7 cm. This finding is consistent with labor curves for nonTOLAC patients. Labor Induction was associated with significant
higher failure rate of TOLAC. According to the data, it seems that
Hispanic/Latina patients may be more interested in TOLAC (78% of
subjects). The study needs to be continued to completion in order to
conclusively answer the research question.

Cassandra Mitchell is a first-year medical student
at Drexel University College of Medicine..
Table 1. Comparison of potential risk factors of failed TOLAC between two cohorts
Risk factors

Successful TOLAC

Failed TOLAC

(N=31)

(n=10)

P value

Age (years)

Mean(SD)

27.2(5.8)

25(6.3)

NS

Gestational age (wks)

Mean(SD)

39.3(1.3)

39.9(1.8)

NS

BMI (kg/m2)

Mean(SD)

34.1(5.2)

35.2(6.7)

NS

Hx prior vaginal delivery

N(%)

8(25%)

2(20%)

NS

Labor induction

N(%)

13(42%)

8 (80%)

0.036

Initial cervical dilatation (cm)

Mean(SD)

2.8(1.6)

2.3(1.7)

NS

Initial cervical effacement (%)

Mean(SD)

68(26.5)

67(13.4)

NS

Epidural placement

N(%)

27(87.1%)

10(100%)

NS

Diabetic

N(%)

5(16.1%)

1(10%)

NS

NICU admission

N(%)

3(9.7%)

2(20%)

NS*

Birth weight (g)

Mean(SD)

3296.9(526.6)

3541.5(513.9)

NS

NS: P>0.05 indicating statistically non-significant

*Risk of type 2 error due to a small sample size
FALL 2018

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Berks County Medical Society Medical Record Fall 2018

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