Uterine rupture during trial of labor: risk management recommendations

In the early 1990s, the cesarean section rate in the United States reached a plateau of approximately 24% of all births. Today, for a variety of reasons, significant efforts are under way to decrease this cesarean rate of almost one in four births. One area of focus is on efforts to decrease the number of "repeat" cesarean sections. Accordingly, the practice of vaginal birth after cesarean section (VBAC) has become commonplace in obstetrical units across the country. Experience now suggests that a history of cesarean delivery increases the risks for mother and child in future deliveries. One of these risks is uterine rupture. This article examines related trends, reviews guidelines promulgated by professional organizations and related literature, and offers risk management and recommendations for mitigating the risks of VBAC.