{
    "abstract": "To evaluate the trends, safety, and feasibility of a trial of labor after cesarean (TOLAC) among kidney and liver transplant recipients.\nThis was a retrospective cohort study using the Transplant Pregnancy Registry International. It included recipients of a kidney or liver transplant with a live-birth pregnancy \u226520\u2009weeks following a prior cesarean, with births between 1967 and 2019 from 289 hospitals, primarily in North America. The primary outcomes of severe maternal morbidity (SMM) and neonatal composite morbidity were compared between those with repeat cesarean deliveries (RCDs), vaginal births after cesarean (VBACs), and failed TOLAC. Multivariable regression was conducted to calculate odds ratios and 95% confidence intervals.\nThe 243 deliveries included in this study were composed of 80.7% RCDs, 10.3% VBACs, and 9.1% with failed TOLAC, with similar demographics between groups. There was no significant difference in incidence of SMM (RCD, 1.0%; VBAC, 4.0%; failed TOLAC, 0%; P\u2009=\u20090.48) or neonatal composite morbidity (RCD, 15.2%; VBAC, 11.5%; failed TOLAC, 4.5%; P\u2009=\u20090.45) between groups. No cases of uterine rupture or neonatal death occurred. Trends in TOLAC demonstrate that the TOLAC rate has declined from 35% in 1989-1994 to 13% in 2014-2019.\nIn this cohort of transplant recipients, TOLAC resulted in successful vaginal delivery over half the time, and did not increase the risk of maternal or neonatal morbidity compared with RCD. We encourage offering transplant recipients a trial of labor after appropriate counseling to decrease the overall rate of cesarean delivery and morbidity in this high-risk population.",
    "authors": [
        {
            "affiliation": "University of California San Francisco School of Medicine, San Francisco, California, USA.",
            "firstname": "Anjali",
            "initials": "A",
            "lastname": "Walia"
        },
        {
            "affiliation": "Division of Maternal Fetal Medicine and Reproductive Genetics, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA.",
            "firstname": "Ophelia",
            "initials": "O",
            "lastname": "Yin"
        },
        {
            "affiliation": "Transplant Pregnancy Registry International, Gift of Life Institute, Philadelphia, Pennsylvania, USA.",
            "firstname": "Lisa A",
            "initials": "LA",
            "lastname": "Coscia"
        },
        {
            "affiliation": "Transplant Pregnancy Registry International, Gift of Life Institute, Philadelphia, Pennsylvania, USA.\nSection of Nephrology, Hypertension, and Kidney Transplantation, Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA.",
            "firstname": "Serban",
            "initials": "S",
            "lastname": "Constantinescu"
        },
        {
            "affiliation": "Division of Transplant Hepatology, Department of Medicine, University of California San Francisco, San Francisco, California, USA.",
            "firstname": "Monika",
            "initials": "M",
            "lastname": "Sarkar"
        },
        {
            "affiliation": "Transplant Pregnancy Registry International, Gift of Life Institute, Philadelphia, Pennsylvania, USA.",
            "firstname": "Michael J",
            "initials": "MJ",
            "lastname": "Moritz"
        },
        {
            "affiliation": "Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California Los Angeles, Los Angeles, California, USA.\nMolecular Biology Institute, University of California Los Angeles, Los Angeles, California, USA.",
            "firstname": "Yalda",
            "initials": "Y",
            "lastname": "Afshar"
        },
        {
            "affiliation": "Division of Maternal Fetal Medicine and Reproductive Genetics, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA.",
            "firstname": "Roxanna A",
            "initials": "RA",
            "lastname": "Irani"
        }
    ],
    "conclusions": null,
    "copyrights": "\u00a9 2025 The Author(s). International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.",
    "doi": "10.1002/ijgo.70013",
    "journal": "International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics",
    "keywords": [
        "maternal morbidity",
        "neonatal morbidity",
        "repeat cesarean",
        "transplant",
        "trial of labor after cesarean",
        "vaginal birth after cesarean"
    ],
    "methods": null,
    "publication_date": "2025-02-19",
    "pubmed_id": "39968735",
    "results": "The 243 deliveries included in this study were composed of 80.7% RCDs, 10.3% VBACs, and 9.1% with failed TOLAC, with similar demographics between groups. There was no significant difference in incidence of SMM (RCD, 1.0%; VBAC, 4.0%; failed TOLAC, 0%; P\u2009=\u20090.48) or neonatal composite morbidity (RCD, 15.2%; VBAC, 11.5%; failed TOLAC, 4.5%; P\u2009=\u20090.45) between groups. No cases of uterine rupture or neonatal death occurred. Trends in TOLAC demonstrate that the TOLAC rate has declined from 35% in 1989-1994 to 13% in 2014-2019.",
    "title": "Safety of a trial of labor after cesarean in kidney and liver transplant recipients: A multicenter cohort study.",
    "xml": "<Element 'PubmedArticle' at 0x788501d488b0>"
}