Delivery following cesarean section and perinatal mortality

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Perinatal Health

Background:

• Analysis of perinatal mortality in women with prior cesarean scars.
• Examining outcomes of repeat elective cesarean sections versus trial of scar (TOS).

Purpose of the Study:

• To analyze perinatal mortality rates (PMR) in patients with previous cesarean scars.
• To compare PMR between elective repeat cesarean sections and TOS.
• To evaluate the safety and efficacy of TOS over time.

Main Methods:

• Retrospective analysis of 1498 deliveries between 1972-1982 in patients with one or more previous cesarean scars.
• Categorization of deliveries into elective repeat cesarean section and TOS groups.
• Calculation and comparison of perinatal mortality rates.

Main Results:

• Overall perinatal mortality rate (PMR) was 30.3/1000, higher than the hospital population (22.5/1000).
• Elective cesarean section had the lowest PMR (10.6/1000).
• TOS group had a corrected PMR twice as high as elective cesarean, but PMR in TOS decreased significantly over the study period.
• Four perinatal deaths were associated with uterine scar dehiscence.

Conclusions:

• Trial of scar (TOS) was associated with increased perinatal mortality compared to elective repeat cesarean section, particularly before the 1980s.
• Improvements in TOS outcomes were observed over time, suggesting enhanced patient selection or management.
• Advocacy for a policy of TOS in selected cases with informed consent, considering the risks of repeat cesarean delivery to the mother.