Vaginal delivery following previous cesarean birth

Because of the rising cesarean birth rate in the United States, renewed interest in vaginal delivery after prior abdominal operation has been evident. In a prospective collaborative study 789 patients were evaluated for inclusion into this investigation. Of the 717 subjects who entered the study 162 chose to attempt vaginal birth and 101 were successful. Desire for tubal sterilization and the lack of prior vaginal delivery were significant correlates of the group selecting repeat abdominal birth and of those who were unsuccessful when vaginal delivery was attempted. There were eight dehiscences and three uterine ruptures among the 717 patients and none was related to catastrophic outcome for the mother or neonate. Perinatal losses (12) were not related to uterine rupture or method of delivery. There were no significant differences in uterine disruption between patients selecting either route of delivery. Likewise ancillary factors such as a prior febrile puerperium (endometritis), number of prior cesarean births, low-vertical uterine incisions, recurrent operative indications, the use of epidural anesthesia, or oxytocin administration were not discriminating factors in whether women chose to attempt or were successful in completing vaginal delivery after prior abdominal birth. From our data vaginal birth after cesarean section appears to be safe if conducted in a carefully selected population that is closely monitored in a prospective manner.