Risk of uterine rupture with a trial of labor in women with multiple and single prior cesarean delivery.
OBJECTIVE
To determine whether the risk for uterine rupture is increased in women attempting vaginal birth after multiple cesarean deliveries.


METHODS
We conducted a prospective multicenter observational study of women with prior cesarean delivery undergoing trial of labor and elective repeat operation. Maternal and perinatal outcomes were compared among women attempting vaginal birth after multiple cesarean deliveries and those with a single prior cesarean delivery. We also compared outcomes for women with multiple prior cesarean deliveries undergoing trial of labor with those electing repeat cesarean delivery.


RESULTS
Uterine rupture occurred in 9 of 975 (0.9%) women with multiple prior cesarean compared with 115 of 16,915 (0.7%) women with a single prior operation (P = .37). Multivariable analysis confirmed that multiple prior cesarean delivery was not associated with an increased risk for uterine rupture. The rates of hysterectomy (0.6% versus 0.2%, P = .023) and transfusion (3.2% versus 1.6%, P < .001) were increased in women with multiple prior cesarean deliveries compared with women with a single prior cesarean delivery attempting trial of labor. Similarly, a composite of maternal morbidity was increased in women with multiple prior cesarean deliveries undergoing trial of labor compared with those having elective repeat cesarean delivery (odds ratio 1.41, 95% confidence interval 1.02-1.93).


CONCLUSIONS
A history of multiple cesarean deliveries is not associated with an increased rate of uterine rupture in women attempting vaginal birth compared with those with a single prior operation. Maternal morbidity is increased with trial of labor after multiple cesarean deliveries, compared with elective repeat cesarean delivery, but the absolute risk for complications is small. Vaginal birth after multiple cesarean deliveries should remain an option for eligible women.


METHODS
II-2.
Landon
Mark B
MB
Department of Obstetrics and Gynecology, Ohio State University, Columbus, Ohio, USA. landon.1@osu.edu
Spong
Catherine Y
CY
Thom
Elizabeth
E
Hauth
John C
JC
Bloom
Steven L
SL
Varner
Michael W
MW
Moawad
Atef H
AH
Caritis
Steve N
SN
Harper
Margaret
M
Wapner
Ronald J
RJ
Sorokin
Yoram
Y
Miodovnik
Menachem
M
Carpenter
Marshall
M
Peaceman
Alan M
AM
O'sullivan
Mary J
MJ
Sibai
Baha M
BM
Langer
Oded
O
Thorp
John M
JM
Ramin
Susan M
SM
Mercer
Brian M
BM
Gabbe
Steven G
SG
D000328:Adult; D017604:Cesarean Section, Repeat / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015999:Multivariate Analysis; D007744:Obstetric Labor Complications / Q000601:surgery; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012042:Registries; D012306:Risk; D014219:Trial of Labor; D014597:Uterine Rupture / Q000453:epidemiology* / Q000209:etiology; D016064:Vaginal Birth after Cesarean / Q000009:adverse effects*