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Vaginal birth following two previous cesarean sections.
F Bretelle1, L Cravello, R Shojai
1Department of Obstetrics & Gynecology B, Hôpital de La Conception, 147 Bvd Baille, 13385, Cedex 5, Marseille, France.
Summary
Trial of labor is a safe option for women with two prior cesarean sections, offering a high vaginal birth rate and low maternal and fetal complications. This approach is generally well-tolerated and effective.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
Background:
- Women with two prior cesarean sections (CS) face complex delivery decisions.
- Previous CS can influence subsequent pregnancy outcomes and delivery management.
Purpose of the Study:
- To evaluate the safety and efficacy of attempting vaginal delivery in women with two previous CS.
- To assess maternal and fetal morbidity associated with trial of labor after two CS.
Main Methods:
- Retrospective study conducted over six years at a university hospital.
- Analysis of 96 selected patients with two uterine scars, cephalic presentation, and normal pelvic dimensions who underwent a trial of labor.
Main Results:
- A vaginal birth rate of 65.6% was achieved following trial of labor.
- Three cases of uterine scar dehiscence occurred, with one requiring hysterectomy due to hemorrhage and uterine atony.
- All neonates had favorable outcomes, though 22 newborns exhibited higher birthweights compared to their siblings from previous CS.
Conclusions:
- Trial of labor is an acceptable management strategy for the majority of women with two prior CS.
- This approach is associated with a high rate of successful vaginal delivery and low maternal and fetal morbidity.