Emergent cesarean delivery in patients undergoing a trial of labor with a transverse lower-segment scar

The American College of Obstetricians and Gynecologists recommends that women with previous low transverse cesarean sections who are candidates for a trial of labor should undergo such a trial only in a special environment. Such recommendations imply that these women are at greater risk than the general population for developing complications necessitating emergent operative intervention. A retrospective review of 5 years' experience reveals that in 1156 term pregnancies in which the patients were given a trial of labor, 18 (1.56%) patients underwent emergent abdominal delivery. This rate and the indications for the emergent operative delivery were not found to be different from those cited for patients without a uterine scar. The incidence of symptomatic uterine rupture was higher in patients scheduled for repeat cesarean section than for patients who underwent a trial of labor. Recommendations for a trial of labor might be reconsidered as they imply an increased risk for maternal and fetal morbidity and mortality that has yet to be demonstrated.