title: Second stage disorders in patients following a previous cesarean section: vacuum versus repeated cesarean section.
abstract: OBJECTIVE
  To investigate whether vacuum extraction due to failure of labor to progress (dystocia) during the second stage in a delivery following a previous cesarean section (CS) is related to increased adverse maternal and perinatal outcomes as compared with repeated CS.
  
  
  METHODS
  A retrospective cohort study of pregnancy and delivery outcomes of patients in their second deliveries attempting a vaginal birth after cesarean (VBAC) following one CS was conducted. Patients who delivered by vacuum extraction were compared with patients who underwent a repeated CS for failure of labor to progress during the second stage.
  
  
  RESULTS
  During the study period, 319 patients with a previous CS suffered from a prolonged second stage of labor in their second delivery. Of these, 184 underwent vacuum extraction and 135 patients underwent a repeated CS. No significant differences in relevant pregnancy complications such as perineal lacerations, uterine rupture, and post-partum hemorrhage and perinatal outcomes were noted between the groups. There were no cases of perinatal mortality in our study.
  
  
  CONCLUSIONS
  When managing second stage labor disorders, vacuum extraction does not seem to be an unsafe procedure in patients with a previous CS.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, POB 151, Beer-Sheva 84101, Israel. kessousr@bgu.ac.il
authors.forename: Roy
authors.initials: R
authors.lastname: Kessous
authors.forename: Dan
authors.initials: D
authors.lastname: Tirosh
authors.forename: Adi Y
authors.initials: AY
authors.lastname: Weintraub
authors.forename: Neta
authors.initials: N
authors.lastname: Benshalom-Tirosh
authors.forename: Ruslan
authors.initials: R
authors.lastname: Sergienko
authors.forename: Eyal
authors.initials: E
authors.lastname: Sheiner
mesh_terms: D017604:Cesarean Section, Repeat; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007748:Labor Stage, Second; D007744:Obstetric Labor Complications / Q000628:therapy*; D011247:Pregnancy; D012189:Retrospective Studies; D014620:Vacuum Extraction, Obstetrical; D016064:Vaginal Birth after Cesarean