University of Massachusetts Medical School Faculty Publications

Association of labor induction or stimulation with infant mortality in women with failed versus successful trial of labor after prior cesarean

Han-Yang Chen, University of Massachusetts Medical School
Suneet P. Chauhan, Eastern Virginia Medical School
William A. Grobman, Northwestern University
Cande V. Ananth, Columbia University
Anthony M. Vintzileos, Winthrop University Hospital
Alfred Z. Abuhamad, Eastern Virginia Medical School


Objective: To compare infant mortality rates among women with a failed versus successful trial of labor after cesarean (TOLAC) following labor induction or stimulation.

Study design: Using US linked birth and infant death cohort data (2000-2004), we identified women who delivered non-anomalous singleton births at 34-41 weeks with TOLAC whose labors were induced or stimulated. Multivariable log-binomial regression models were fitted to estimate the association between TOLAC success and infant mortality.

Results: Of the 164,113 women who underwent TOLAC, 41% were unsuccessful. After adjustment for potential confounding factors, a failed TOLAC was associated with a 1.4 fold (95% confidence interval [CI] 1.1, 1.7) increased risk of infant mortality.

Conclusions: Among women undergoing labor induction or stimulation, a failed TOLAC is associated with higher likelihood of infant mortality.