title: More than one previous cesarean delivery: a 5-year experience with 435 patients.
abstract: OBJECTIVE
  To evaluate the obstetric outcome of patients who have had more than one previous cesarean delivery, and to compare it with that of patients with one previous cesarean.
  
  
  METHODS
  Medical records of 435 women with more than one previous cesarean and 1206 with one previous cesarean, and who delivered at our institution in the period 1987-1991, were reviewed retrospectively. All adverse outcomes related to uterine wound separation identified in medical records were reviewed individually. Statistical analysis of outcome used chi 2 test, Fisher exact test, and odds ratios with 95% confidence intervals.
  
  
  RESULTS
  Uterine wound separation occurred in nine of 435 patients with more than one previous cesarean compared with 16 of 1206 with a single previous cesarean (2.1 versus 1.3%, not significant). Of those undergoing a trial of labor, separations occurred in six of 302 and 12 of 1110 patients with more than one and a single previous operation, respectively (2.0 versus 1.1%, not significant). Vaginal birth after cesarean was successful less often in women with more than one previous cesarean than in those with one previous operation (64 versus 77%, P < .05). Important adverse outcomes were infrequent and not related to the number of previous cesareans.
  
  
  CONCLUSIONS
  Our findings support allowing a trial of labor for patients with more than one previous cesarean delivery under conditions that permit prompt recognition and treatment of emergencies.
authors.affiliation: Department of Obstetrics and Gynecology, Mount Sinai Hospital Medical Center, Chicago Medical School, Illinois, USA.
authors.forename: H
authors.initials: H
authors.lastname: Asakura
authors.forename: S A
authors.initials: SA
authors.lastname: Myers
mesh_terms: D002585:Cesarean Section / Q000706:statistics & numerical data*; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data; D007226:Infant Mortality; D007231:Infant, Newborn; D016017:Odds Ratio; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D013529:Surgical Wound Dehiscence / Q000453:epidemiology; D014219:Trial of Labor; D014597:Uterine Rupture / Q000453:epidemiology