Maternal and Perinatal Outcomes Associated with a Trial of Labor after Prior Cesarean Delivery

doi:10.1056/NEJMoa040405

Volume 351:2581-2589		December 16, 2004		Number 25

Maternal and Perinatal Outcomes Associated with a Trial of Labor after Prior Cesarean Delivery

Mark B. Landon, M.D., John C. Hauth, M.D., Kenneth J. Leveno, M.D., Catherine Y. Spong, M.D., Sharon Leindecker, M.S., Michael W. Varner, M.D., Atef H. Moawad, M.D., Steve N. Caritis, M.D., Margaret Harper, M.D., Ronald J. Wapner, M.D., Yoram Sorokin, M.D., Menachem Miodovnik, M.D., Marshall Carpenter, M.D., Alan M. Peaceman, M.D., Mary Jo O'Sullivan, M.D., Baha Sibai, M.D., Oded Langer, M.D., John M. Thorp, M.D., Susan M. Ramin, M.D., Brian M. Mercer, M.D., Steven G. Gabbe, M.D., for the National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network

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by Greene, M. F.

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ABSTRACT

Background The proportion of women who attempt vaginal deliveryafter prior cesarean delivery has decreased largely becauseof concern about safety. The absolute and relative risks associatedwith a trial of labor in women with a history of cesarean delivery,as compared with elective repeated cesarean delivery withoutlabor, are uncertain.

Methods We conducted a prospective four-year observational studyof all women with a singleton gestation and a prior cesareandelivery at 19 academic medical centers. Maternal and perinataloutcomes were compared between women who underwent a trial oflabor and women who had an elective repeated cesarean deliverywithout labor.

Results Vaginal delivery was attempted by 17,898 women, and15,801 women underwent elective repeated cesarean delivery withoutlabor. Symptomatic uterine rupture occurred in 124 women who underwent a trial of labor (0.7 percent).Hypoxic–ischemicencephalopathy occurred in no infants whose mothers underwentelective repeated cesarean delivery and in 12 infants born atterm whose mothers underwent a trial of labor (P<0.001).Seven of these cases of hypoxic–ischemic encephalopathyfollowed uterine rupture (absolute risk, 0.46 per 1000 womenat term undergoing a trial of labor), including two neonataldeaths. The rate of endometritis was higher in women undergoinga trial of labor than in women undergoing repeated electivecesarean delivery (2.9 percent vs. 1.8 percent), as was therate of blood transfusion (1.7 percent vs. 1.0 percent). Thefrequency of hysterectomy and of maternal death did not differsignificantly between groups (0.2 percent vs. 0.3 percent, and0.02 percent vs. 0.04 percent, respectively).

Conclusions A trial of labor after prior cesarean delivery isassociated with a greater perinatal risk than is elective repeatedcesarean delivery without labor, although absolute risks arelow. This information is relevant for counseling women abouttheir choices after a cesarean section.

Source Information

From the Departments of Obstetrics and Gynecology at Ohio State University, Columbus (M.B.L.); University of Alabama at Birmingham, Birmingham, (J.C.H.); University of Texas Southwestern, Dallas (K.J.L.); National Institute of Child Health and Human Development, Bethesda, Md. (C.Y.S.); George Washington University Biostatistics Center, Washington, D.C. (S.L.); University of Utah, Salt Lake City (M.W.V.); University of Chicago, Chicago (A.H.M.); University of Pittsburgh and Magee Women's Hospital, Pittsburgh (S.N.C.); Wake Forest University, Winston-Salem, N.C. (M.H.); Thomas Jefferson University, Philadelphia (R.J.W.); Wayne State University, Detroit (Y.S.); University of Cincinnati, Cincinnati, and Columbia University, New York (M.M.); Brown University, Providence, R.I. (M.C.); Northwestern University, Chicago (A.M.P.); University of Miami, Miami (M.O.); University of Tennessee, Memphis (B.S.); University of Texas–San Antonio, San Antonio (O.L.); University of North Carolina, Chapel Hill (J.M.T.); University of Texas–Houston, Houston (S.M.R.); Case Western Reserve University, Cleveland (B.M.M.); and Vanderbilt University, Nashville (S.G.G.).

Address reprint requests to Dr. Landon at Ohio State University College of Medicine and Public Health, 1654 Upham Dr., Means Hall, 5th Fl., Columbus, OH 43210-1228, or at landon.1{at}osu.edu.

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N Engl J Med 2005; 352:1718-1720, Apr 21, 2005. Correspondence

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Agnew, G., Turner, M. (2006). Can a 29% Cesarean Delivery Rate Possibly Be Justified?. Obstet Gynecol 108: 452-452 [Full Text]
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Nisenblat, V., Barak, S., Griness, O. B., Degani, S., Ohel, G., Gonen, R. (2006). Maternal complications associated with multiple cesarean deliveries.. Obstet Gynecol 108: 21-26 [Abstract] [Full Text]
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Zweifler, J., Garza, A., Hughes, S., Stanich, M. A, Hierholzer, A., Lau, M. (2006). Vaginal Birth After Cesarean in California: Before and After a Change in Guidelines. Ann Fam Med 4: 228-234 [Abstract] [Full Text]
Leeman, L. M., Plante, L. A. (2006). Patient-Choice Vaginal Delivery?. Ann Fam Med 4: 265-268 [Abstract] [Full Text]
Declercq, E., Menacker, F., MacDorman, M. (2006). Maternal Risk Profiles and the Primary Cesarean Rate in the United States, 1991-2002. Am. J. Public Health 96: 867-872 [Abstract] [Full Text]
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Gonen, R., Nisenblat, V., Barak, S., Tamir, A., Ohel, G. (2006). Results of a Well-Defined Protocol for a Trial of Labor After Prior Cesarean Delivery. Obstet Gynecol 107: 240-245 [Abstract] [Full Text]
Juhasz, G., Gyamfi, C., Gyamfi, P., Tocce, K., Stone, J. L. (2005). Effect of Body Mass Index and Excessive Weight Gain on Success of Vaginal Birth After Cesarean Delivery. Obstet Gynecol 106: 741-746 [Abstract] [Full Text]
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(2005). Trial of labour carries small but real increase in risk. BMJ 330: - [Full Text]
Johnson, K. C, Daviss, B.-A. (2005). Results of the National Study of Vaginal Birth After Cesarean in Birth Centers. Obstet Gynecol 105: 897-898 [Full Text]
(2005). Elective Repeat Cesarean: Safer for Baby and Mom. JWatch Women's Health 2005: 4-4 [Full Text]
(2005). Vaginal Birth After C-Section: Riskier Than Repeat C-Section. JWatch General 2005: 4-4 [Full Text]
Greene, M. F. (2004). Vaginal Birth after Cesarean Revisited. NEJM 351: 2647-2649 [Full Text]

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