Vaginal birth after cesarean section in a university setting.
Despite numerous reports in the literature almost universally endorsing the safety of a trial of labor after a prior cesarean section, it is used in only a small fraction of eligible patients. Our investigation, conducted at the University of Louisville, examines the safety of such a protocol. Two thousand seven hundred fifty-seven patients were delivered during one year; 282 had a history of at least one prior cesarean section. Of the 259 patients eligible, 218 (84%) underwent a trial of labor, and 168/218 (77%) were delivered vaginally. There were 6 cases of uterine dehiscence and 1 uterine rupture. No hysterectomies were performed. Maternal morbidity was significantly greater in the failed trial-of-labor group. There was one perinatal death that was unrelated to a trial of labor. A previous diagnosis of cephalopelvic disproportion or failure to progress did not preclude a trial of labor, and 69% of these patients delivered vaginally. Our data suggest that a trial of labor following one or more previous cesarean sections is a safe option in a carefully selected population.
Turnquest
M A
MA
Department of Obstetrics and Gynecology, University of Louisville, KY 40292.
James
T
T
Marcell
C
C
Spinnato
J A
JA
D002585:Cesarean Section / Q000009:adverse effects; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007744:Obstetric Labor Complications; D011247:Pregnancy; D014219:Trial of Labor; D016064:Vaginal Birth after Cesarean