title: Obstetric outcome associated with trial of labor in women with three prior cesarean delivery and at least one prior vaginal birth in an area with a particularly high rate of cesarean delivery.
abstract: OBJECTIVE
  The objective of this study is to evaluate maternal and neonatal outcomes associated with trial of labor after cesarean (TOLAC) in women with three prior cesarean delivery (CD) and at least one prior vaginal delivery.
  
  
  METHODS
  This is a retrospective study using data collected from clinical records of women three prior CD and at least one prior vaginal delivery who were referred to our unit. Maternal and perinatal outcomes were compared between women with three prior CD who underwent TOLAC and those who underwent planned repeated CD (i.e. control group). The primary outcome was a composite of maternal complications including at least one of the followings: need for blood transfusion, uterine rupture, hysterectomy, and admission to intensive care unit.
  
  
  RESULTS
  Fifty singleton gestations with three prior CD at with at least one prior vaginal birth were analyzed. Of them, 10 accepted to undergo TOLAC. Of the 10 women who underwent TOLAC, nine had vaginal birth and one had CD for non-reassuring pattern. We found no significant differences in the primary outcome, in need for blood transfusion, in the incidence of uterine rupture, hysterectomy, and admission to intensive care unit comparing TOLAC group with controls.
  
  
  CONCLUSIONS
  TOLAC in women with three prior CD and at least one prior vaginal delivery is a viable option and is not associated with higher risk of adverse maternal or fetal outcomes.
authors.affiliation: a Department of Obstetrics and Gynecology , Ospedale Buon Consiglio Fatebenefratelli , Naples , Italy and.
authors.forename: Roberto
authors.initials: R
authors.lastname: Vigorito
authors.affiliation: a Department of Obstetrics and Gynecology , Ospedale Buon Consiglio Fatebenefratelli , Naples , Italy and.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Montemagno
authors.affiliation: b Department of Neuroscience , Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II , Naples , Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Saccone
authors.affiliation: a Department of Obstetrics and Gynecology , Ospedale Buon Consiglio Fatebenefratelli , Naples , Italy and.
authors.forename: Renato
authors.initials: R
authors.lastname: De Stefano
mesh_terms: D000328:Adult; D001724:Birth Weight; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007558:Italy; D007744:Obstetric Labor Complications / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D010343:Patient Admission / Q000706:statistics & numerical data; D011247:Pregnancy; D012189:Retrospective Studies; D014219:Trial of Labor; D016064:Vaginal Birth after Cesarean / Q000706:statistics & numerical data*
keywords: Cesarean; induction; labor; neonatal outcome; vaginal birth