An evaluation of the relative risks of a trial of labor versus elective repeat cesarean section

A retrospective study of a trial of labor (TOL) after prior cesarean section was conducted over 18 months in a patient population that is homogeneous with regard to race, socioeconomic class, gestational age, and medical complications. Of 171 women who had undergone previous cesarean sections, 75 were offered a TOL. Thirty-five of these patients had an elective repeat cesarean section, while 40 agreed to a TOL. Thirty-two of the latter patients delivered vaginally (80%). The criteria for offering a TOL and a protocol for TOL are presented. A comparison of the maternal and neonatal morbidity associated with repeat cesarean section versus TOL do not strongly favor either method of delivery in our population. The patients who had undergone cesarean section for cephalopelvic disproportion (CPD) had the lowest acceptance and the lowest success rate of a TOL. The hospital charges and hospital stay of the two groups are presented. The financial aspects of the two methods of delivery and the impact of Diagnosis Related Groups (DRGs) on the management of these patients are discussed. Careful selection of patients for a TOL is essential to maintain the quality of medical care while responding to pressures to reduce the cesarean section rate and to reduce the costs of medical care.