Trial of labor in patients with multiple previous cesarean sections

Trial of labor (TOL) in patients with multiple previous low transverse cesarean sections has not been investigated extensively, and information regarding the risks and benefits of this kind of management is largely unavailable. A combined series of patients experienced a TOL after two or more previous cesarean deliveries; the rate of vaginal delivery was 66%, and there was virtually no morbidity. Though a larger number of patients is necessary to document the desirability of a TOL in these circumstances, the evidence available now suggests that this management approach is both reasonable and safe.