Comparison of maternal mortality and morbidity between trial of labor and elective cesarean section among women with previous cesarean delivery.
OBJECTIVE
This study was undertaken to assess the safety of trial of labor after previous cesarean delivery.


METHODS
Retrospective cohort study of 308,755 Canadian women with previous cesarean delivery between 1988 and 2000. Occurrences of in-hospital maternal death, uterine rupture, and other severe maternal morbidity were compared between women with a trial of labor and those with an elective cesarean section.


RESULTS
Rates of uterine rupture (0.65%), transfusion (0.19%), and hysterectomy (0.10%) were significantly higher in the trial-of-labor group. Maternal in-hospital death rate, however, was lower in the trial-of-labor group (1.6 per 100,000) than in the elective cesarean section group (5.6 per 100,000). The association between trial of labor and uterine rupture was stronger in low volume (<500) than in high volume (> or =500 births per year) obstetric units.


CONCLUSIONS
Trial of labor is associated with increased risk of uterine rupture, but elective cesarean section may increase the risk of maternal death.
Wen
Shi Wu
SW
Division of Health Surveillance and Epidemiology, Centre for Healthy Human Development, Health Canada, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada. swwen@ohri.ca
Rusen
I D
ID
Walker
Mark
M
Liston
Robert
R
Kramer
Michael S
MS
Baskett
Tom
T
Heaman
Maureen
M
Liu
Shiliang
S
D001803:Blood Transfusion / Q000706:statistics & numerical data; D002170:Canada; D002585:Cesarean Section / Q000401:mortality; D017558:Elective Surgical Procedures; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data; D008428:Maternal Mortality; D009017:Morbidity; D011247:Pregnancy; D014219:Trial of Labor; D014597:Uterine Rupture / Q000453:epidemiology