title: Trial of labour after two or three previous caesarean sections.
abstract: OBJECTIVE
  To investigate the safety of a trial of labour (TOL) after two or three previous caesarean sections.
  
  
  METHODS
  Retrospective analysis of medical records of women with a history of more than one previous caesarean section who gave birth during a 10-year period (1988-1997) in two large university hospitals in The Netherlands.
  
  
  RESULTS
  Women numbering 30,132 gave birth with a hospital caesarean birth rate of 14.8%. There were 246 women with a history of more than one previous caesarean section: 187 (76%) delivered by elective repeat caesarean section (ERCS); 59 (24%) had a trial of labour, of whom 49 (83%) had a vaginal birth. Three uterine ruptures occurred after previous lower segment caesarean sections without maternal or perinatal mortality related to the uterine rupture; only one rupture was during a trial of labour. In the study group there was no maternal mortality. Maternal morbidity did not differ between women with an elective repeat caesarean or a failed trial of labour. Perinatal mortality was not related to the mode of delivery.
  
  
  CONCLUSIONS
  Elective repeat caesarean section is not the only answer to a woman with two or three previous caesarean sections. A trial of labour can be a safe option for a selected group of women.
authors.affiliation: Department of Obstetrics and Gynaecology, Gelre Ziekenhuis, P.O. Box 9014, 7300 DS, Apeldoorn, The Netherlands. w.spaans@gelre.nl
authors.forename: Wilbert A
authors.initials: WA
authors.lastname: Spaans
authors.forename: Laura M E
authors.initials: LM
authors.lastname: van der Vliet
authors.forename: Elisabeth A M
authors.initials: EA
authors.lastname: Röell-Schorer
authors.forename: Otto P
authors.initials: OP
authors.lastname: Bleker
authors.forename: Jos
authors.initials: J
authors.lastname: van Roosmalen
mesh_terms: D017604:Cesarean Section, Repeat / Q000706:statistics & numerical data*; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D008428:Maternal Mortality; D009017:Morbidity; D011247:Pregnancy; D014219:Trial of Labor; D014597:Uterine Rupture / Q000453:epidemiology