title: Adverse obstetric outcomes in women with previous cesarean for dystocia in second stage of labor.
abstract: OBJECTIVE
  To evaluate obstetric outcomes in women undergoing a trial of labor (TOL) after a previous cesarean for dystocia in second stage of labor.
  
  
  METHODS
  A retrospective cohort study of women with one previous low transverse cesarean undergoing a first TOL was performed. Women with previous cesarean for dystocia in first stage and those with previous dystocia in second stage were compared with those with previous cesarean for nonrecurrent reasons (controls). Multivariable regressions analyses were performed.
  
  
  RESULTS
  Of 1655 women, those with previous dystocia in second stage of labor (n = 204) had greater risks than controls (n = 880) to have an operative delivery [odds ratio (OR): 1.5; 95% confidence intervals (CI) 1.1 to 2.2], shoulder dystocia (OR: 2.9; 95% CI 1.1 to 8.0), and uterine rupture in the second stage of labor (OR: 4.9; 95% CI 1.1 to 23), and especially in case of fetal macrosomia (OR: 29.6; 95% CI 4.4 to 202). The median second stage of labor duration before uterine rupture was 2.5 hours (interquartile range: 1.5 to 3.2 hours) in these women.
  
  
  CONCLUSIONS
  Previous cesarean for dystocia in the second stage of labor is associated with second-stage uterine rupture at next delivery, especially in cases of suspected fetal macrosomia and prolonged second stage of labor.
authors: Department of Obstetrics and Gynaecology, Faculty of Medicine, Hôpitaux Universitaires de Genève, Université de Genève, Genève, Suisse.
authors: Nicole
authors: N
authors: Jastrow
authors: Suzanne
authors: S
authors: Demers
authors: Robert J
authors: RJ
authors: Gauthier
authors: Nils
authors: N
authors: Chaillet
authors: Normand
authors: N
authors: Brassard
authors: Emmanuel
authors: E
authors: Bujold
mesh_terms: D000328:Adult; D002585:Cesarean Section; D016001:Confidence Intervals; D004420:Dystocia / Q000601:surgery*; D005260:Female; D005320:Fetal Macrosomia / Q000150:complications; D006801:Humans; D007747:Labor Stage, First; D007748:Labor Stage, Second; D015999:Multivariate Analysis; D016017:Odds Ratio; D011247:Pregnancy; D012189:Retrospective Studies; D013997:Time Factors; D014219:Trial of Labor; D014597:Uterine Rupture / Q000209:etiology*; D016064:Vaginal Birth after Cesarean / Q000009:adverse effects*