Elective Repeat Cesarean Delivery Versus Trial of Labor

TLDR

The study compares outcomes of trial of labor versus elective repeat cesarean in a prospective multicenter cohort. All women with prior cesarean at Kaiser Permanente Southern California hospitals were included, regardless of planned delivery mode. Among 7,229 women, 70% attempted labor, 75% of those delivered vaginally, uterine rupture occurred in <1% with no deaths, and elective cesarean was associated with longer stays, more transfusions and fevers; overall labor after prior cesarean has a 75% success rate but carries some risk. Citation: Obstet Gynecol 1994;83:927-32.

Abstract

Objective: To report a prospective multicenter comparison of outcomes of patients who attempted trial of labor and those who underwent elective repeat cesarean. Methods: During the study interval, all pregnant women with previous cesarean delivery cared for at Kaiser Permanente Hospitals in Southern California were studied regardless of whether trial of labor or elective repeat cesarean was planned. Results: Of 7229 study patients, 5022 (70%) had a trial of labor and 2207 had elective repeat cesarean operations. Seventy-five percent (3746) of those opting for trial of labor went on to deliver vaginally. The rate of uterine rupture was less than 1% and there were no maternal deaths related to uterine rupture. The hospital length of stay, incidence of postpartum transfusion, and incidence of postpartum fever were all significantly higher in the elective repeat cesarean group than in the trial of labor group. Conclusions: Labor after previous cesarean delivery has a 75% success rate, with a risk of uterine rupture of less than 1%. Neither repeat cesarean delivery nor trial of labor is risk-free. With careful supervision, trial of labor eliminates the need for a large proportion of repeat cesarean operations.(Obstet Gynecol 1994;83:927-32)