Trial of Labor Tied to Better Delivery Outcomes in Transplant Recipients

THURSDAY, Oct. 14, 2021 (HealthDay News) — Among pregnant women who are kidney and liver transplant recipients, trial of labor (TOL) is associated with improved neonatal outcomes compared with scheduled cesarean delivery (CD), according to a study published online Oct. 4 in JAMA Network Open.

Ophelia Yin, M.D., from University of California Los Angeles, and colleagues used data from the Transplant Pregnancy Registry International to identify recipients of a kidney (1,435) or liver (430) transplant who gave birth as an adult (at or later than 20 weeks’ gestational age) and who delivered between 1968 and 2019. Associations between mode of obstetrical delivery and maternal and neonatal morbidity were evaluated.

The researchers found that compared with a scheduled CD, a TOL with CD or vaginal delivery (VD) was not associated with increased severe maternal morbidity among kidney transplant recipients; the numbers for liver transplant recipients were too small for multivariate modeling. In the adjusted model, TOL was associated with a decrease in neonatal composite morbidity for kidney transplant recipients who underwent TOL-CD or TOL-VD, as well as liver transplant recipients who underwent TOL-VD but not TOL-CD. The rate of CD was 51.6 percent among kidney transplant recipients and 41.4 percent among liver transplant recipients. However, 49.9 percent of kidney transplant recipients and 47.6 percent of liver transplant recipients had scheduled CDs performed for either a nonmedical indication or a repeated indication, although individuals with these indications were candidates for a TOL.

“The findings suggest that, for kidney and liver transplant recipients, a trial of labor instead of scheduled cesarean delivery is associated with improved neonatal outcomes without compromising maternal health,” conclude the authors.

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