Trial of labour after two or three previous caesarean sections

• Published in: European journal of obstetrics & gynecology and reproductive biology 2003-09, Vol.110 (1), p.16-19
• Main Authors: Spaans, Wilbert A., van der Vliet, Laura M.E., Röell-Schorer, Elisabeth A.M., Bleker, Otto P., van Roosmalen, Jos
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Caesarean section; Cesarean Section, Repeat - statistics & numerical data; Delivery, Obstetric - statistics & numerical data; Delivery. Postpartum. Lactation; Female; Gynecology. Andrology. Obstetrics; Humans; Infant Mortality; Infant, Newborn; Male; Maternal Mortality; Medical sciences; Morbidity; Multiple previous caesarean sections (MPCS); Obstetrical techniques; Pregnancy; Trial of Labor; Trial of labour; Uterine rupture; Uterine Rupture - epidemiology; Vaginal birth after caesarean section (VBAC)
• ISSN: 0301-2115; 1872-7654
• DOI: 10.1016/S0301-2115(03)00082-4

Objective: To investigate the safety of a trial of labour (TOL) after two or three previous caesarean sections. Study design: Retrospective analysis of medical records of women with a history of more than one previous caesarean section who gave birth during a 10-year period (1988–1997) in two large university hospitals in The Netherlands. Results: Women numbering 30,132 gave birth with a hospital caesarean birth rate of 14.8%. There were 246 women with a history of more than one previous caesarean section: 187 (76%) delivered by elective repeat caesarean section (ERCS); 59 (24%) had a trial of labour, of whom 49 (83%) had a vaginal birth. Three uterine ruptures occurred after previous lower segment caesarean sections without maternal or perinatal mortality related to the uterine rupture; only one rupture was during a trial of labour. In the study group there was no maternal mortality. Maternal morbidity did not differ between women with an elective repeat caesarean or a failed trial of labour. Perinatal mortality was not related to the mode of delivery. Conclusion: Elective repeat caesarean section is not the only answer to a woman with two or three previous caesarean sections. A trial of labour can be a safe option for a selected group of women.