Objective To determine whether the indication for a previous cesarean delivery is associated with the risk of uterine rupture among women undergoing a trial of labor after cesarean (TOLAC). Design Retrospective cohort study. Setting Single university-affiliated tertiary medical center. Population or Sample Women with a singleton pregnancy at ≥24 weeks’ gestation, one prior low-transverse cesarean delivery, and an attempted TOLAC between 2012 and 2024. Methods Previous cesarean delivery indications were categorized as antepartum indications, suspected fetal distress, first-stage dystocia, or second-stage dystocia. Cases of uterine dehiscence were excluded. Multivariable logistic regression was used to evaluate the association between prior cesarean indication and uterine rupture, adjusting for relevant maternal and intrapartum factors. Main Outcome Measures Complete uterine rupture. Results Among 147,045 deliveries, 7,340 women underwent TOLAC, of whom 91 (1.2%) experienced uterine rupture. A previous cesarean delivery performed for second-stage dystocia was significantly more common among women with uterine rupture than among those without rupture (12.1% vs 3.2%, p<0.001). In multivariable analysis, prior second-stage dystocia remained independently associated with uterine rupture (adjusted odds ratio 3.9, 95% confidence interval 1.14–13.37). No other prior cesarean indication was independently associated with rupture risk. Conclusions Among women undergoing TOLAC, a prior cesarean delivery performed for second-stage dystocia is independently associated with an increased risk of uterine rupture. Incorporating prior cesarean indication into counselling and intrapartum risk assessment may improve individualized clinical decision-making.

Objective: To evaluate the predictive value of maternal neutrophil-to-lymphocyte ratio (NLR) for spontaneous delivery within 24 hours in women with preterm premature rupture of membranes (PPROM). Study Design and setting: Retrospective cohort study in a single, university-affiliated tertiary medical center. Population: Women with PPROM at <33+6 weeks’ gestation planning vaginal delivery. Exclusions included cases of labor induction or cesarean delivery. Main outcome measure: Women who delivered spontaneously within 24 hours from rupture of membrane Methods: Maternal demographic and clinical data, including age, gestational age, body mass index, parity, and mode of conception, were collected. Women who delivered spontaneously within 24 hours of membrane rupture were compared to those who did not via univariate and multivariate Cox analyses.   Results:  Among 145,833 deliveries during the study period, 1,442 women (0.9%) presented with PPROM. After exclusions, 249 women were included, with 115 (46.2%) delivering spontaneously within 24 hours. Cox regression analysis identified NLR >10 (HR = 2.86, 95% CI 1.42–5.7, p = 0.003) and multiple gestation (HR = 5.87, 95% CI 2.57–13.45, p < 0.001) as independent risk factors for spontaneous delivery within 24 hours. Conclusion: An elevated maternal NLR is a promising predictor of spontaneous delivery within 24 hours in PPROM cases. These findings support the potential of NLR as a practical clinical tool for anticipating imminent preterm delivery, aiding in management decisions for this population. Funding: None.