Vaginal birth following two cesarean deliveries--are the risks exaggerated?
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.
Garg
Vibha Kailash
VK
Department of Obstetrics & Gynecology, Al Hasa Health Center (Saudi Aramco Medical Services Organization), Saudi Aramco, Al Hasa, Saudi Arabia. gargvk@aramco.com
Ekuma-Nkama
E N
EN
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*