Trial of labour versus elective caesarean delivery for estimated large for gestational age foetuses after prior caesarean delivery: a multicenter retrospective study.

BACKGROUND: Lower rates of successful trial of labor after cesarean (TOLAC) in association with fetal macrosomia were previously reported. This study aimed to compare TOLAC to elective caesarean delivery (CD) in women with estimated fetal weight large for gestational age (eLGA) and a prior CD. Primary outcome was to analyse the mode of delivery in case of TOLAC. Secondary outcome was to compare maternal and foetal morbidity. METHODS: We conducted a retrospective, descriptive, multicentric, cohort study in five maternity units between January and December 2020. Inclusion criteria were: women with a single prior CD and eLGA or neonatal weight > 90th percentile with singleton pregnancy and gestational age ≥ 37 weeks. MAIN OUTCOME MEASURES: rate of vaginal delivery, maternal and fetal morbidity including: shoulder dystocia, neonatal hospitalization, fetal trauma, neonatal acidosis, uterine rupture, 3rd and 4th perineal tears, post-partum hemorrhage, and a need for blood transfusion. RESULTS: Four hundred forty women met inclusion criteria, including 235 (53.4%) eLGA. 170 (72.3%) had a TOLAC (study group) and 65 (27.7%) an elective CD (control). 117 (68.82%) TOLAC had a vaginal delivery. No significant differences were found between the two groups in the rates of: postpartum haemorrhage, transfusion, Apgar score, neonatal hospitalization, and foetal trauma. Cord lactate was higher in the case of TOLAC (3.2 vs 2.2, p < 0.001). Median fetal weight was 3815 g (3597-4085) vs. 3865 g (3659-4168): p = 0.068 in the study vs. controls group respectively. CONCLUSION: TOLAC for eLGA fetuses is legitimate because there is no difference in maternal-fetal morbidity, and the CD rate is acceptable.

[Assessing post-internship residents' criteria for their future place of gynecological/obstetric practice in Lorraine]. / Évaluation des critères de choix du futur lieu d'exercice chez les internes lorrains de gynécologie .

OBJECTIVE: Assessing criteria of post-internship choices of residents registered to postgraduate study in gynecology-obstetric (GO) and incentive measures which may impact the attractiveness of maternity hospitals. METHODS: A regional anonymous survey composed of four parts was performed between 2015 and 2016 with 39 residents in GO from Lorraine. RESULTS: The answer rate was 89.7% with 80% of women in the specialty. 97.1% of residents have considered a fellowship, 28.6% as a university assistant. 88.6% wanted to stay in an attractive city. 51.4% of the residents wanted to be an obstetrician, 37.1% a gynecological surgeon and 11.4% an Assisted Reproductive Technology doctor. 82.8% of the residents wanted to work in a public hospital. Among the 31 residents for whom the type of maternity was a criteria of choice, 58.1% opted for a type II maternity, 32.2% a type III and only 9.7% a type I. A timeshare job between two hospitals could be an option for 94.3% of residents whereas becoming a private physician was considered by only 2.9% of them. 42.4% of them explained this choice by the possibility of keeping a multi-directional practice. CONCLUSION: Gynecology-Obstetrics residents want to keep a multi-directional practice in an attractive maternity unit according to their activities, safety of practice, highest levels of health care and also to their demographic situation. This favors the progressive closing of small structures, for the benefit of larger structures.