Vaginal birth after cesarean section in rural Zaire. Changing concepts

The safety of trials of labor after cesarean section has yet to be established in developing countries. Centre Médical Evangélique is a referral hospital in rural northeastern Zaire. From August 1, 1989, to January 15, 1990, 33 women with previous cesarean deliveries were offered a trial of labor. Of them, 22 (67%) had successful vaginal deliveries. The indications for the previous cesarean section did not influence the outcome of the trial of labor. There was a high rate of immediate maternal morbidity but no significant long-term morbidity. The rate of uterine dehiscence was 9.1%. The perinatal death rate, 60.1/1,000, was similar to the overall rate for the institution. Trials of labor after cesarean section are a valid therapeutic option in developing countries.