Factors associated with maternal choice of planned mode of delivery after cesarean.

INTRODUCTION: Among women with a single prior cesarean delivery, the planned mode of delivery is chosen by the woman following appropriate counseling on the risks and benefits of elective repeat cesarean delivery (ERCD) versus trial of labor after cesarean (TOLAC). This study aimed to identify factors associated with the choice of planned mode of delivery in this population. METHODS: This retrospective single-center cohort study included women with a single prior cesarean delivery and no subsequent delivery, who gave birth to a singleton in cephalic presentation at or beyond 37 weeks of gestation between January 2023 and December 2024. Women with any contraindication to TOLAC were excluded. Demographic and obstetrical characteristics were compared between women who chose ERCD and those who chose TOLAC, using univariate and multivariate analyses. RESULTS: During the study period, 685 women with a single prior cesarean delivery gave birth at our institution. Of these, 465 met the inclusion criteria: 345 (74.2%) in the TOLAC group and 120 (25.8%) in the ERCD group. Overall, 46.5% of women in the TOLAC group had cesarean delivery. Women in the ERCD group were significantly older (median age 35 [IQR 32-38] vs. 34 [IQR 30-37] years, p = 0.008) and more frequently overweight (BMI ≥ 25 kg/m2 before pregnancy: 46.7% vs. 33.3%, p = 0.01). The rate of assisted reproductive technology conception was higher in the ERCD group (15.8% vs. 6.7%, p = 0.01), as was the rate of suspected macrosomia (33.3% vs. 17.8%, p < 0.01). Women in the ERCD group suffered significantly less from social deprivation (3.5% vs. 11.1%, p = 0.02). On multivariate analysis, only mode of conception and suspected macrosomia remained independently associated with the choice of ERCD (respectively ORa 2.38 [1.10-5.12] and ORa 2.40 [1.41-4.08]. CONCLUSION: One in four women with a single prior cesarean delivery opted for elective repeat cesarean delivery. Mode of conception and estimated fetal weight large for gestational age were independently associated with the maternal choice of ERCD.