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Related Experiment Videos

Twice a cesarean, always a cesarean?

J P Phelan1, M O Ahn, F Diaz

  • 1Department of Obstetrics and Gynecology, University of Southern California School of Medicine, Los Angeles.

Obstetrics and Gynecology
|February 1, 1989
PubMed
Summary

Women with two prior cesarean births can safely attempt a vaginal birth. A trial of labor in these patients showed a lower uterine dehiscence rate and successful vaginal delivery, especially with oxytocin use.

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Area of Science:

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

Background:

  • Cesarean delivery rates have significantly increased over the past two decades.
  • Alternatives to cesarean birth are gaining attention, including vaginal birth after cesarean (VBAC).
  • Vaginal birth after one previous cesarean is an established option.

Purpose of the Study:

  • To evaluate the safety and outcomes of a trial of labor for women with two previous cesarean deliveries.
  • To determine if women with a history of two cesareans can achieve successful vaginal birth.

Main Methods:

  • Prospective data collection from July 1982 to June 1986 on women with previous cesareans.
  • Exclusion of women with classical incisions or contraindications to labor.

Related Experiment Videos

  • Analysis of trial of labor outcomes in women with two prior cesareans.

    • Main Results:

    • Of 1088 women with two prior cesareans, 501 (46%) attempted a trial of labor, with 346 (69%) achieving vaginal delivery.
    • The uterine dehiscence rate was 1.8% in the trial of labor group versus 4.6% in those who did not attempt labor.
    • Oxytocin use was associated with successful vaginal delivery and a dehiscence rate of 2.1%.

    Conclusions:

    • Trial of labor appears to be a reasonable consideration for carefully selected women with two previous cesarean deliveries.
    • Successful vaginal birth is significantly related to oxytocin use and prior vaginal delivery history.
    • This study supports VBAC for women with two prior cesareans, challenging the routine elective repeat cesarean.