Trial of labor after one previous cesarean delivery for multifetal gestation.
OBJECTIVE
To estimate success rates and risks with a trial of labor after one previous cesarean delivery for multifetal gestation compared with one previous cesarean delivery for a singleton pregnancy.


METHODS
Patients from the National Institute of Child Health and Human Development Maternal Fetal Medicine Units Network Cesarean Registry with one previous cesarean delivery and a current term singleton pregnancy were identified. Cases had one previous cesarean delivery for a multifetal pregnancy. Controls had one previous cesarean delivery for a singleton pregnancy.


RESULTS
Of cases, 556 of 944 (58.9%) attempted a trial of labor. Of controls, 13,923 of 29,329 (47.5%) attempted a trial of labor. The trial of labor success rate was 85.6% among cases and 73.1% among controls (odds ratio 2.19, 95% confidence interval 1.72-2.78). Compared with trial of labor controls, cases had no statistically increased risk of transfusion, endometritis, intensive care unit admissions, uterine rupture, or perinatal complications. Cases in this analysis with a successful trial of labor were more likely to have previously had a successful vaginal birth after cesarean (37.1% compared with 14.1%, P<.001).


CONCLUSIONS
Women with one previous cesarean delivery for a multifetal gestation have high trial of labor success rates and low complication rates.
Varner
Michael W
MW
Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah 84132, USA. mvarner@hsc.utah.edu
Thom
Elizabeth
E
Spong
Catherine Y
CY
Landon
Mark B
MB
Leveno
Kenneth J
KJ
Rouse
Dwight J
DJ
Moawad
Atef H
AH
Simhan
Hyagriv N
HN
Harper
Margaret
M
Wapner
Ronald J
RJ
Sorokin
Yoram
Y
Miodovnik
Menachem
M
Carpenter
Marshall
M
Peaceman
Alan
A
O'sullivan
Mary J
MJ
Sibai
Baha M
BM
Langer
Oded
O
Thorp
John M
JM
Ramin
Susan M
SM
Mercer
Brian M
BM
D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome; D011272:Pregnancy, Multiple; D011446:Prospective Studies; D014219:Trial of Labor; D016064:Vaginal Birth after Cesarean / Q000706:statistics & numerical data*