title: Unsuccessful trial of labor in women with and without previous cesarean delivery.
abstract: OBJECTIVE
  To compare maternal and neonatal outcomes after unsuccessful labor in women with and those without prior cesarean delivery.
  
  
  METHODS
  This was a retrospective cohort study of all women in labor delivered by cesarean section (CS) from November 2004 through December 2006. The study population was dichotomized by previous CS and compared for various maternal and neonatal outcomes. Student t-test, χ² and Fisher exact tests were used for analysis.
  
  
  RESULTS
  There was a significantly higher rate of symptomatic uterine rupture [3/100 (3%) vs. 0/449 (0%), p = 0.006], asymptomatic uterine scar dehiscence [6/100 (6%) vs. 0/449 (0%), p = 0.0001], and bladder injury [2/100 (2%) vs. 0/100 (0%), p = 0.001], among women with prior cesarean delivery compared to those without. The rate of respiratory distress syndrome [(6/100) (6%) vs. 10/449 (2.2%), p = 0.05] and meconium aspiration [4/100 (4%) vs. 2/449 (0.4%), p = 0.01] was also significantly higher among neonates of women with prior cesarean delivery. However, the rate of endomyometritis [3/100 (3%) vs. 50/449 (11.1%), p = 0.009] and febrile morbidity [17/100 (17%) vs. 144/449 (32.1%), p  = 0.003] was significantly lower among women with prior cesarean delivery compared to those without prior cesarean birth.
  
  
  CONCLUSIONS
  Compared to laboring women without previous cesarean delivery, women with previous cesarean delivery have increased maternal and neonatal morbidity. Febrile morbidity was, however, lower among women with previous cesarean delivery. These differential findings should further inform our perinatal counseling of women contemplating trial of labor after a previous cesarean delivery.
authors.affiliation: Department of Obstetrics & Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA. andrew-elimian@ouhsc.edu
authors.forename: Andrea
authors.initials: A
authors.lastname: Palmer
authors.forename: Andrew
authors.initials: A
authors.lastname: Elimian
authors.forename: Jean R
authors.initials: JR
authors.lastname: Goodman
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Knudtson
authors.forename: Michelle
authors.initials: M
authors.lastname: Rodriguez
authors.forename: Elisa
authors.initials: E
authors.lastname: Crouse
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007744:Obstetric Labor Complications / Q000453:epidemiology* / Q000601:surgery; D009825:Oklahoma / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D012189:Retrospective Studies; D014219:Trial of Labor; D016064:Vaginal Birth after Cesarean; D055815:Young Adult