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Related Experiment Videos

Vaginal birth after cesarean section: current opinion

D Weinstein1, A Benshushan, Y Ezra

  • 1Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.

International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics
|April 1, 1996
PubMed
Summary

Women with prior cesarean sections can attempt a trial of labor, even with multiple previous cesareans. This approach is evaluated for safety and efficacy, considering induction methods and specific prior cesarean indications.

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Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine

Background:

  • Trial of labor after cesarean (TOLAC) is established for women with one prior cesarean.
  • Controversies persist regarding TOLAC eligibility for women with multiple prior cesareans and use of induction agents.

Purpose of the Study:

  • To review current literature and recent clinical experience on controversies surrounding trial of labor after cesarean (TOLAC).
  • To address specific questions regarding TOLAC in women with multiple prior cesareans, use of oxytocin/prostaglandins, and indications for repeat cesarean.
  • To evaluate the safety and efficacy of TOLAC in complex cases.

Main Methods:

  • Literature review of English-language studies on trial of labor after cesarean.
  • Analysis of clinical experience from a tertiary medical center over the past decade.

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  • Discussion of specific patient subgroups and indications for repeat cesarean delivery.

    • Main Results:

    • Evidence supports TOLAC in carefully selected women with multiple prior cesareans.
    • Use of oxytocin during TOLAC is generally considered safe.
    • Certain indications for prior cesarean may warrant a repeat cesarean, but others do not preclude TOLAC.

    Conclusions:

    • Careful patient selection and counseling are crucial for successful trial of labor after cesarean.
    • Shared decision-making is essential when considering induction agents or managing specific indications for repeat cesarean.
    • Further research may clarify optimal management strategies for complex TOLAC cases.