title: Vaginal birth following two cesarean deliveries--are the risks exaggerated?
abstract: BACKGROUND
  Prior to 1996, most women who had undergone two previous cesarean deliveries were offered only cesarean delivery at Al-Hasa Health Centre. A policy of trial of labor was instituted in 1996. We compared the outcome of trial of labor versus cesarean delivery in women with a history of two previous cesarean deliveries who delivered between 1997 and 2002.
  
  
  METHODS
  All patients with a history of two previous lower segment cesarean deliveries were included in the study. Those considered suitable were permitted a trial of labor that was neither induced nor augmented at any stage.
  
  
  RESULTS
  Of the 205 patients in the study, 66 delivered vaginally (32.2%), 68 had an emergency cesarean delivery (33.2%), and 71 an elective cesarean delivery (34.6%). No scar dehiscence was observed, nor was hysterectomy performed in either group. The rate of complications was lower in the vaginal delivery group (4.5%) than in the cesarean delivery group (19.4%).
  
  
  CONCLUSIONS
  Trial of labor in women with a history of two cesarean deliveries is a reasonable consideration, and when carried out without the use of oxytocics or prostaglandins, is associated with reduced maternal morbidity with no difference in perinatal morbidity.
authors.affiliation: Department of Obstetrics & Gynecology, Al Hasa Health Center (Saudi Aramco Medical Services Organization), Saudi Aramco, Al Hasa, Saudi Arabia. gargvk@aramco.com
authors.forename: Vibha Kailash
authors.initials: VK
authors.lastname: Garg
authors.forename: E N
authors.initials: EN
authors.lastname: Ekuma-Nkama
mesh_terms: D005260:Female; D006801:Humans; D011183:Postoperative Complications; D011247:Pregnancy; D011256:Pregnancy Outcome; D012306:Risk; D016896:Treatment Outcome; D014219:Trial of Labor; D016064:Vaginal Birth after Cesarean / Q000379:methods*