Related Experiment Videos
Is vaginal birth after two or more cesarean sections safe?
K M Pruett1, B Kirshon, D B Cotton
1Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
Obstetrics and Gynecology
|August 1, 1988
Summary
Women with multiple prior cesarean sections can attempt a trial of labor. Success rates were lower with oxytocin augmentation, but vaginal birth is a viable option.
Area of Science:
- Obstetrics and Gynecology
- Reproductive Medicine
Background:
- Trial of labor after cesarean (TOLAC) is a common practice.
- Previous uterine surgery, including multiple cesarean sections, can influence TOLAC outcomes.
- Assessing the safety and efficacy of TOLAC in women with a history of multiple cesarean deliveries is crucial.
Observation:
- Fifty-five patients with at least two prior cesarean sections attempted a trial of labor.
- Uterine incision types varied, with most being of unknown type.
- Oxytocin augmentation was required in 55% of cases.
Findings:
- The overall vaginal delivery success rate was 45%.
- Patients requiring oxytocin augmentation had a significantly lower incidence of vaginal delivery (30% vs. 64%).
- Scar separation occurred in three patients, with two requiring hysterectomy; no maternal or neonatal deaths were reported.
Implications:
- A history of multiple cesarean sections does not necessarily preclude a trial of labor.
- Careful patient selection and monitoring are essential for successful TOLAC in this population.
- Further research may elucidate optimal management strategies for women with multiple prior cesareans undergoing TOLAC.