title: [Maternal benefits and risks of trial of labor versus elective repeat caesarean delivery in women with a previous caesarean delivery].
abstract: OBJECTIVE
  To assess maternal outcomes during trial of labor (TOL) and elective repeat caesarean delivery (ERCD) in women with a previous caesarean delivery.
  
  
  METHODS
  French and English publications were searched using PubMed and Cochrane Library.
  
  
  RESULTS
  Maternal mortality remains a very rare event regardless of the planned mode of delivery (EL2). It is potentially reduced after a TOL but the presence of biases in many studies does not allow any conclusion (EL3). Maternal morbidity is mainly due to the failure of the TOL and to the risk of unplanned caesarean delivery during labor (EL2). The risk of complete uterine rupture significantly increases with TOL versus ERCD but it remains low at about 0.2 to 0.8% for women with one scar on the uterus (EL2). The occurrence of a post-surgical wound, mostly from the bladder, is rare (less than 0.5%) regardless of the planned mode of delivery (EL2). Facing the risk of hemorrhage requiring hysterectomy or blood transfusion, data are heterogeneous because of the nature of the populations studied. These risks do not seem to vary with the mode of delivery (EL3). The risk of post-partum venous thrombo-embolic complications and infections (endometritis and maternal fever) appears to be similar in both TOL and ERCD (EL3). The risk of infection is primarily related to the additional presence of obesity (EL2). While maternal morbidity progressively increases with the number of iterative caesarean sections, maternal morbidity in TOL after a previous caesarean delivery decreases with the number of successful TOL (EL2).
  
  
  CONCLUSIONS
  In patients with a previous caesarean delivery, the risks of maternal complications are rare and similar between TOL and ERCD. There is an increased risk of complete uterine rupture in case of TOL. Nevertheless TOL has a favorable benefit/risk balance in most cases and its success reduces the risk of short and long-term maternal complications (EL3).
authors.affiliation: Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen cedex 9, France. beucher-g@chu-caen.fr
authors.forename: G
authors.initials: G
authors.lastname: Beucher
authors.forename: P
authors.initials: P
authors.lastname: Dolley
authors.forename: S
authors.initials: S
authors.lastname: Lévy-Thissier
authors.forename: A
authors.initials: A
authors.lastname: Florian
authors.forename: M
authors.initials: M
authors.lastname: Dreyfus
mesh_terms: D002585:Cesarean Section / Q000009:adverse effects; D017604:Cesarean Section, Repeat / Q000009:adverse effects*; D002921:Cicatrix / Q000150:complications; D005260:Female; D006801:Humans; D008428:Maternal Mortality; D009017:Morbidity; D011247:Pregnancy; D011256:Pregnancy Outcome; D018570:Risk Assessment; D012307:Risk Factors; D014219:Trial of Labor; D014591:Uterine Diseases / Q000150:complications; D014597:Uterine Rupture / Q000453:epidemiology; D016064:Vaginal Birth after Cesarean / Q000009:adverse effects*