Vaginal birth following two cesarean deliveries--are the risks exaggerated?

Prior to 1996, most women who had undergone two previous cesarean deliveries were offered only cesarean delivery at Al-Hasa Health Centre. A policy of trial of labor was instituted in 1996. We compared the outcome of trial of labor versus cesarean delivery in women with a history of two previous cesarean deliveries who delivered between 1997 and 2002.

All patients with a history of two previous lower segment cesarean deliveries were included in the study. Those considered suitable were permitted a trial of labor that was neither induced nor augmented at any stage.

Of the 205 patients in the study, 66 delivered vaginally (32.2%), 68 had an emergency cesarean delivery (33.2%), and 71 an elective cesarean delivery (34.6%). No scar dehiscence was observed, nor was hysterectomy performed in either group. The rate of complications was lower in the vaginal delivery group (4.5%) than in the cesarean delivery group (19.4%).

Trial of labor in women with a history of two cesarean deliveries is a reasonable consideration, and when carried out without the use of oxytocics or prostaglandins, is associated with reduced maternal morbidity with no difference in perinatal morbidity.