Elective repeat cesarean delivery versus trial of labor: a prospective multicenter study

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Reproductive Health

Background:

• Vaginal birth after cesarean (VBAC) is a significant consideration for women with prior cesarean deliveries.
• Elective repeat cesarean delivery is an alternative, but carries its own set of risks and resource implications.

Purpose of the Study:

• To prospectively compare outcomes between patients attempting trial of labor and those undergoing elective repeat cesarean.
• To evaluate the safety and efficacy of trial of labor in women with a history of cesarean delivery.

Main Methods:

• A prospective, multicenter study comparing trial of labor versus elective repeat cesarean.
• Inclusion criteria encompassed all pregnant women with previous cesarean delivery at Kaiser Permanente Hospitals in Southern California.

Main Results:

• Out of 7229 patients, 70% attempted trial of labor, with a 75% vaginal delivery success rate.
• Uterine rupture occurred in less than 1% of trial of labor cases, with no related maternal deaths.
• Elective repeat cesarean was associated with significantly higher hospital length of stay, postpartum transfusion, and postpartum fever rates.

Conclusions:

• Trial of labor after cesarean delivery demonstrates a 75% success rate with a uterine rupture risk below 1%.
• Both trial of labor and repeat cesarean delivery have associated risks.
• Supervised trial of labor effectively reduces the necessity for a substantial number of repeat cesarean operations.