title: [Trial of labor after two cesarean sections: the policy in Israel and four years experience].
abstract: BACKGROUND
  Trial of vaginal birth after caesarean is considered acceptable after one caesarean section. However, trial of vaginal birth after more than one caesarean section is still unaccepted by most clinicians. Birth rates in Israel are within the highest in the western world and many women are interested in a trial of labor after two previous caesarean sections. Therefore, it is crucial to establish evidence based guidelines for this issue.
  
  
  OBJECTIVE
  To perform a systematic review of literature on success rate of vaginal birth after two caesarean sections and to present our experience in trial of labor after two caesarean sections.
  
  
  METHODS
  We searched MEDLINE, using search terms "Caesarean section", "caesarian", "C*rean", "C*rian", "Vaginal birth after caesarean section", "Trial of labor".
  
  
  RESULTS
  The literature revealed a success rate of 60-80%. The main complication is rupture of the uterus and its rate is 0-3%. During the years 2006-2009, 67 trials of labor after two caesarean sections were performed in our medical center. Our success rate is 88%. There were no cases of rupture of the uterus.
  
  
  CONCLUSIONS
  A trial of labor after two caesarean sections is possible for carefully selected women and when appropriate medical resources are available.
authors.affiliation: Department of Obstetrics & Gynecology, Hadassah Hebrew University MedicaL Center, Ein-Kerem, Jerusalem, Israel. lironkogan@yahoo.com
authors.forename: Liron
authors.initials: L
authors.lastname: Kogan
authors.forename: Uri
authors.initials: U
authors.lastname: Dior
authors.forename: Neta
authors.initials: N
authors.lastname: Eizenberg
authors.forename: Yossef
authors.initials: Y
authors.lastname: Ezra
mesh_terms: D017604:Cesarean Section, Repeat / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007557:Israel; D007744:Obstetric Labor Complications / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011256:Pregnancy Outcome; D014219:Trial of Labor; D014597:Uterine Rupture / Q000453:epidemiology / Q000209:etiology; D016064:Vaginal Birth after Cesarean / Q000009:adverse effects / Q000706:statistics & numerical data*