title: Vaginal delivery in the grand multipara following previous lower segment cesarian section.
abstract: OBJECTIVE
  To examine the effect of attempting vaginal birth after cesarian section in the grand multipara with one previous cesarian section scar in the uterus.
  
  
  METHODS
  Over 5-year period (1990-1994) mothers with 6 or more previous deliveries and with a previous section scar in the uterus were identified. The outcome in these patients who attempted vaginal birth was reviewed.
  
  
  RESULTS
  Of the 85 patients with the combination of both grand multiparity and a previous cesarian section scar in the uterus, 45 attempted a trial of labor. Twenty-seven patients (60%) achieved successful uncomplicated vaginal delivery. There was a relatively high incidence of serious complications.
  
  
  CONCLUSIONS
  Vaginal birth after cesarian section can be achieved in some grand multiparas with a previous scar in the uterus. There is an increased risk of serious complications. The labor should be very closely supervised and early intervention arranged if there is not smooth rapid progress.
authors.affiliation: Department of Obstetrics and Gynecology, Tawam Hospital, Abu Dhabi, United Arab Emirates.
authors.forename: C
authors.initials: C
authors.lastname: Dyack
authors.forename: P F
authors.initials: PF
authors.lastname: Hughes
authors.forename: J B
authors.initials: JB
authors.lastname: Simbakalia
mesh_terms: D002585:Cesarean Section; D017604:Cesarean Section, Repeat; D002921:Cicatrix; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D010298:Parity; D011247:Pregnancy; D011256:Pregnancy Outcome; D014219:Trial of Labor; D014599:Uterus