Seminars in Perinatology
Volume 34, Issue 4 , Pages 249-257, August 2010

Birth After Previous Cesarean Delivery: Short-Term Maternal Outcomes

  • Mona T. Lydon-Rochelle, PhD, MPH

      Affiliations

    • National Perinatal Epidemiology Centre, Department of Obstetrics and Gynecology, University of College, Cork, Cork, Ireland
    • Department of Epidemiology and Public Health, School of Medicine, University of College, Cork, Cork, Ireland
    • Corresponding Author InformationAddress reprint requests to Mona T. Lydon-Rochelle, National Perinatal Epidemiology Centre, Cork University, Maternity Hospital, 5th Floor, Cork, Ireland
    • ,
  • Alison G. Cahill, MD, MSCI

      Affiliations

    • Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO
    • ,
  • Catherine Y. Spong, MD

      Affiliations

    • Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD

An estimated 40% of the 1.3 million cesarean deliveries performed each year in the United States are repeat procedures. The appropriate clinical management approach for women with previous cesarean delivery remains challenging because options are limited. The risks and benefits of clinical management choices in the woman’s health need to be quantified. Thus, we discuss the available published scientific data on (1) the short-term maternal outcomes of trial of labor after cesarean and elective repeat cesarean delivery, (2) the differences between outcomes for both, (3) the important factors that influence these outcomes, and (4) successful vs. unsuccessful vaginal birth after cesarean. For women with a previous cesarean delivery, a successful trial of labor offers several distinct, consistently reproducible advantages compared with elective repeat cesarean delivery, including fewer hysterectomies, fewer thromboembolic events, lower blood transfusion rates, and shorter hospital stay. However, when trial of labor after cesarean fails, emergency cesarean is associated with increased uterine rupture, hysterectomy, operative injury, blood transfusion, endometritis, and longer hospital stay. Care of women with a history of previous cesarean delivery involves a confluence of interactions between medical and nonmedical factors; however, the most important determinants of the short-term outcomes among these women are likely individualized counseling, accurate clinical diagnoses, and careful management during a trial of labor. We recommend a randomized controlled trial among women undergoing a TOLAC and a longitudinal cohort study among women with previous cesarean to evaluate adverse outcomes, with focused attention on both mother and the infant.

Keywords: repeat cesarean section, trial of labor, vaginal birth after cesarean, cesarean, uterine rupture, pregnancy outcome, NIH Consensus Development Conference

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 This work was supported in part by the National Perinatal Epidemiology Center, University of College Cork, Cork, Ireland.

PII: S0146-0005(10)00028-5

doi:10.1053/j.semperi.2010.03.004

Seminars in Perinatology
Volume 34, Issue 4 , Pages 249-257, August 2010

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