title: The safety of a trial of labor after cesarean section in a grandmultiparous population.
abstract: BACKGROUND
  The rate of vaginal birth after a cesarean (VBAC) delivery in the multiparous population has decreased largely in recent years because of maternal and neonatal complications. The clinical management of grand multiparous (GMP) women (>5 births) with a prior cesarean delivery is even less clear. The purpose of the present study was to assess the risks of maternal and neonatal complications associated with VBAC compared to that of repeated elective cesarean section (CS) in the GMP population.
  
  
  METHODS
  A retrospective study of 1,102 GMP women with a singleton gestation and a prior single CS was conducted. Data were retrieved from the database of the Department of Obstetrics and Gynecology at the Soroka University Medical Center, Beer Sheva, Israel. Maternal and neonatal outcomes were compared between women who underwent a successful VBAC attempt, women who had failed in a trial of labor and women who had an elective repeated CS.
  
  
  RESULTS
  Six hundred and nineteen women (56%) underwent a successful VBAC, 155 (14%) underwent a trail of labor and 328 (30%) had an elective repeated CS. Women who had a successful VBAC required less blood transfusion, and had less puerperal fever diseases (P < 0.001). Induction or augmentation of labor was associated with failure of VBAC (P < 0.001). No significant differences in neonatal complications were observed between the groups. No significant difference in uterine dehiscence, uterine rupture, amnionitis, postpartum hemorrhage, hysterectomy, puerperal fever and thromboembolic diseases was observed between the groups.
  
  
  CONCLUSIONS
  A successful VBAC in the GMP population was not associated with a higher risk of maternal complications in comparison with a repeated elective CS.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, 84101, Israel.
authors.forename: Eitan
authors.initials: E
authors.lastname: Kugler
authors.forename: Ilana
authors.initials: I
authors.lastname: Shoham-Vardi
authors.forename: Eliezer
authors.initials: E
authors.lastname: Burstien
authors.forename: Moshe
authors.initials: M
authors.lastname: Mazor
authors.forename: Reli
authors.initials: R
authors.lastname: Hershkovitz
mesh_terms: D000328:Adult; D017604:Cesarean Section, Repeat / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007557:Israel / Q000453:epidemiology; D007751:Labor, Induced; D008423:Maternal Age; D008875:Middle Aged; D010298:Parity; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011644:Puerperal Disorders; D012189:Retrospective Studies; D014219:Trial of Labor; D016064:Vaginal Birth after Cesarean / Q000009:adverse effects* / Q000706:statistics & numerical data