Perinatal outcomes after successful and failed trials of labor after cesarean delivery.
OBJECTIVE
To compare maternal and neonatal outcomes after successful and failed trials of labor after cesarean in women at term, excluding uterine ruptures, and to examine predictors of successful and failed trials of labor.


METHODS
Matched maternal and neonatal data from 1993-1999 in women with singleton term pregnancies with prior cesarean undergoing trial of labor were reviewed. Women with uterine rupture were excluded. Maternal and neonatal outcomes were analyzed for successful and failed trials. Predictors of success and failure were examined.


RESULTS
1284 women and their neonates were available for analysis. 1094 (85.2%) had a vaginal birth and 190 (14.8%) underwent repeat cesarean. Failed trials of labor were associated with higher incidence of choriamnionitis (25.8% vs. 5.5%, P<.001), postpartum hemorrhage (35.8% vs. 15.8%, P<.001), hysterectomy (1% vs. 0%, P=.022), neonatal jaundice (17.4% vs.10.2%, P=.004) and composite major neonatal morbidities (6.3% vs. 2.8%, P=.014).


CONCLUSIONS
Failed trial of labor in women at term with prior cesarean is associated with increased maternal and neonatal morbidities.
El-Sayed
Yasser Y
YY
Department of Obstetrics and Gynecology, Stanford University Medical Center, Stanford, CA, USA.
Watkins
Melanie M
MM
Fix
Megan
M
Druzin
Maurice L
ML
Pullen
Kristin M
KM
Caughey
Aaron B
AB
D000138:Acidosis / Q000453:epidemiology; D000328:Adult; D000767:Anesthesia, Epidural; D000773:Anesthesia, Obstetrical; D001720:Birth Injuries / Q000453:epidemiology; D001724:Birth Weight; D002140:California / Q000453:epidemiology; D002543:Cerebral Hemorrhage / Q000453:epidemiology; D002585:Cesarean Section / Q000706:statistics & numerical data*; D002821:Chorioamnionitis / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data; D007231:Infant, Newborn; D007567:Jaundice, Neonatal / Q000453:epidemiology; D015999:Multivariate Analysis; D011014:Pneumonia / Q000453:epidemiology; D006473:Postpartum Hemorrhage / Q000453:epidemiology; D011247:Pregnancy; D044469:Racial Groups; D012127:Respiratory Distress Syndrome, Newborn / Q000453:epidemiology; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology; D014219:Trial of Labor; D014470:Umbilical Cord / Q000737:chemistry; D016064:Vaginal Birth after Cesarean / Q000706:statistics & numerical data*