Background In an attempt to reduce the rate of cesarean section,obstetricians now offer a trial of labor to pregnant women whohave had a previous cesarean section. Although a trial of laboris usually successful and is relatively safe, few studies havedirectly addressed the maternal and perinatal morbidity andmortality associated with this method of delivery.
Methods We performed a population-based, longitudinal studyof 6138 women in Nova Scotia who had previously undergone cesareansection and had delivered a singleton live infant in the periodfrom 1986 through 1992.
Results A total of 3249 women elected a trial of labor, and2889 women chose to undergo a second cesarean section. Therewere no maternal deaths. The overall rate of maternal morbiditywas 8.1 percent; 1.3 percent had major complications (a needfor hysterectomy, uterine rupture, or operative injury) and6.9 percent had minor complications (puerperal fever, a needfor blood transfusion, or abdominal-wound infection). Althoughthe overall rate of maternal complications did not differ significantlybetween the women who chose a trial of labor and the women whoelected cesarean section (odds ratio for the trial-of-laborgroup, 0.9; 95 percent confidence interval, 0.8 to 1.1), majorcomplications were nearly twice as likely among women undergoinga trial of labor (odds ratio, 1.8; 95 percent confidence interval,1.1 to 3.0). Apgar scores, admission to the neonatal intensivecare unit, and perinatal mortality were similar among the infantswhose mothers had a trial of labor and those whose mothers underwentelective cesarean section.
Conclusions Among pregnant women who have had a cesarean section,major maternal complications are almost twice as likely amongthose whose deliveries are managed with a trial of labor asamong those who undergo an elective second cesarean section.
In the United States and Canada, up to one quarter of all infantsare delivered by cesarean section1,2,3,4,5; approximately halfthese procedures are performed only because the woman has hada previous cesarean section.1 For years, allowing labor aftera previous cesarean section was thought to be dangerous, andmany clinicians recommended that any woman who had had a cesareansection should deliver all subsequent babies by cesarean section.However, others have questioned the necessity for elective cesareansection in many such cases and have considered a trial of laborafter a previous cesarean section a reasonable strategy. In1980, the Consensus Development Conference on Cesarean Childbirthwas convened at the National Institutes of Health to considerwhether a subsequent cesarean section was always necessary.6The participants concluded that vaginal delivery after previouslow transverse cesarean section was a safe and acceptable option.6In May 1985, the National Consensus Conference on Aspects ofCesarean Birth in Canada recommended that a trial of labor beoffered to women with "one previous low transverse cesareansection, a singleton vertex presentation, and no absolute indicationfor cesarean section (such as placenta previa)."7 Among womenwho attempt a trial of labor after a previous low transversecesarean section, 60 to 80 percent have vaginal deliveries,8,9,10,11,12and morbidity is lower among women who have a vaginal deliveryafter a previous cesarean section than among women who electto undergo a second cesarean section.10,13,14 The relevant issue,however, is the morbidity and mortality associated with thetrial of labor and not the risk associated with vaginal deliveryafter a previous cesarean section. We therefore studied maternaland perinatal morbidity and mortality in a group of women whounderwent either a trial of labor or an elective second cesareansection after a previous cesarean delivery.
Methods
Study Design
The study data were obtained from the Nova Scotia Atlee PerinatalDatabase of the Reproductive Care Program of Nova Scotia, Canada,for the years 1986 through 1992. The program includes 2 tertiarycare hospitals, 7 regional hospitals, and 18 community hospitals.Data collection began in 1980 at the tertiary care hospitals,in 1986 at the regional hospitals, and in 1988 at the communityhospitals. In Nova Scotia, tertiary care hospitals provide carefor pregnant women with all levels of risk. Regional hospitalsprovide care for women at low or moderate risk and refer womenwith high-risk pregnancies to tertiary care hospitals. Communityhospitals provide care for low-risk women and refer higher-riskwomen to hospitals with appropriate levels of care.
From 1986 to 1988, approximately 80 percent of pregnant womenin the province were registered in the perinatal data base,but after 1988 all women who delivered infants with birth weightsof 500 g or more or at 20 weeks' gestation or later were registered.Standardized information was obtained on each pregnancy at thetime of the initial prenatal visit and thereafter throughoutthe pregnancy and postpartum periods by trained nurses or physicians.This information was abstracted from the medical records anddischarge summaries by trained health-records personnel andcoded for data entry. All complications and conditions werecoded by the medical-records personnel according to a standardcoding scheme.
After the National Consensus Conference in 1985, physicianswere encouraged to discuss a trial of labor with all pregnantwomen who had undergone a previous low transverse cesarean section.The recommendation to proceed with a trial of labor or electivecesarean section was usually made in the outpatient settingby a physician. The decision to perform a second cesarean sectionwhen the infant was not delivered during a trial of labor wasbased on obstetrical indications such as the failure of laborto progress or fetal–pelvic disproportion and was madeby the physician in charge.
There were 82,488 births from 1986 through 1992 in Nova Scotia.Of the 6457 women who had previously undergone one cesareansection, 319 were excluded from our analysis for the followingreasons: nonvertex presentation (119 women); multiple gestation(118 women); a previous cesarean section with a vertical orT-shaped incision (37 women); placenta previa (36 women); maternalherpes simplex infection (7 women); and previous uterine surgerysuch as myomectomy (2 women).
During labor, uterine activity and the fetal heart rate weremonitored. When indicated, oxytocin was used for induction andaugmentation of labor. Analgesia with nitrous oxide, narcoticanalgesia, and pudendal, epidural, and general anesthesia wereused when necessary.
The 3249 women who attempted vaginal delivery after one previouslow transverse cesarean section and the 2889 women who electedto undergo a second cesarean section were compared with respectto certain demographic and maternal characteristics, and perinataland maternal morbidity and mortality were evaluated. Women wereclassified with respect to morbidity as having no complications,major complications, or minor complications. Major complicationswere defined as the need for hysterectomy, uterine rupture,and operative injury, whereas minor complications were definedas puerperal fever, the need for a blood transfusion, and abdominal-woundinfection. Women with multiple major complications or both majorand minor complications were counted only once and coded ashaving major complications; women with multiple minor complicationswere counted only once and coded as having minor complications.
Hysterectomy was defined as the surgical removal of the uterusand cervix, with or without adnexectomy. Uterine rupture wasdefined as a defect that involved the entire wall of the uterus,that was symptomatic, and that required operative intervention.Operative injury included extension of the uterine incisionwith laceration of one or both uterine arteries or lacerationof the bladder, ureter, or bowel. Sources of puerperal fever(temperature, >38.0°C) included uterine, urinary, pulmonary,or wound infection and sepsis. Urinary tract infections werediagnosed when culture showed more than 100,000 colonies permilliliter. Pulmonary infection included all cases of pneumonia.The diagnosis of sepsis was made only if the woman had positiveblood cultures. Transfusions were performed at the discretionof the physician. Abdominal-wound infection was defined as thepresence of purulent material at the wound site and was notedby the attending physician.
Statistical Analysis
For statistical analysis, we used Stata software (Stata, CollegeStation, Tex.) and Epi Info, version 6 (Centers for DiseaseControl and Prevention, Atlanta). Initial comparisons were madewith the chi-square test or Fisher's exact test for categoricaldata and Student's t-test or analysis of variance for continuousdata. Maternal age, parity, tobacco use, type of hospital, maritalstatus, and attendance at a prenatal class and the infant'sbirth weight were examined for interaction and confounding.Our analysis revealed no significant interaction among thesecovariates. Multivariate logistic-regression analysis was usedto control for the simultaneous effects of covariates. Adjustedodds ratios and 95 percent confidence intervals were derivedfrom the estimated regression coefficients.
Results
Of the 6138 women, 3249 (52.9 percent) chose to undergo a trialof labor, and 2889 (47.1 percent) elected a second cesareansection. The characteristics of the women in the two groupsare shown in Table 1. Women 19 years old or younger and those30 years old or older were more likely to attempt a trial oflabor than to undergo elective cesarean section. Although allthe women had undergone only one previous cesarean section,1030 also had had at least one successful vaginal delivery (eitherbefore the pregnancy in which they underwent a primary cesareansection or as a result of a previous successful trial of labor).Among these 1030 women, those who had had one previous vaginaldelivery and those who had had two or more were 3.2 and 4.0times as likely, respectively, to undergo a trial of labor aswomen who had had no previous vaginal deliveries. Women whoattended prenatal classes were more likely to undergo a trialof labor than those who did not. Elective second cesarean sectionwas twice as likely to occur at a regional hospital as at atertiary care hospital and 2.5 times as likely to occur at acommunity hospital. The infants' Apgar scores and the ratesof admission to a neonatal intensive care unit were similarin the two groups. The perinatal mortality rate was 9 per 1000live births in the trial-of-labor group and 5 per 1000 birthsin the group that underwent elective cesarean section (P = 0.09).
Table 1. Characteristics of Pregnant Women Undergoing a Trial of Labor or an Elective Second Cesarean Section in Nova Scotia from 1986 through 1992.
Overall, 8.1 percent of the women had a complication. Complicationswere major (need for hysterectomy, ruptured uterus, or operativeinjury) in 1.3 percent and minor (puerperal fever, need fora blood transfusion, or abdominal-wound infection) in 6.9 percent.None of the women died. The overall rates of maternal complicationsin the two groups were similar (Table 2). Major complicationswere 1.8 times as likely in the trial-of-labor group as in theelective-cesarean-section group, whereas minor complicationswere 20 percent less likely.
Table 2. Morbidity in Pregnant Women Who Chose a Trial of Labor or an Elective Second Cesarean Section in Nova Scotia from 1986 through 1992.
With respect to major complications, five women in the trial-of-laborgroup and six women in the elective-cesarean-section group underwenthysterectomy. Ten women in the trial-of-labor group had uterinerupture; two required hysterectomy, and the remaining eightunderwent surgical repair. One woman in the elective-cesarean-sectiongroup had a uterine defect requiring repair. Two perinatal deathsoccurred among the infants of women in the trial-of-labor groupand were related to uterine rupture. The risk of operative injuryto the mother was almost twice as high in the trial-of-laborgroup as in the elective-cesarean-section group. The risk ofpuerperal fever was 25 percent higher in the elective-cesarean-sectiongroup. The risk of requiring a blood transfusion in the twogroups was not significantly different. The risk of abdominal-woundinfection was more than one and a half times higher in the elective-cesarean-sectiongroup than in the trial-of-labor group.
Among the 1030 women who had previously had both a cesareansection and at least one vaginal delivery, overall morbidityincreased with an increasing number of previous vaginal deliveriesamong the women who elected a second cesarean section, althoughnot among the women in the trial-of-labor group (Figure 1, left-handpanel). However, major complications were almost twice as likelyto occur in the trial-of-labor group as in the elective-cesarean-sectiongroup, unless a woman had had two successful vaginal deliveries;in that case, major complications were more likely in the elective-cesarean-sectiongroup (Figure 1, center panel). The frequency of minor complicationsincreased with an increasing number of previous vaginal deliveriesin the elective-cesarean-section group but not in the trial-of-laborgroup (Figure 1, right-hand panel).
Figure 1. Morbidity as a Function of Increasing Parity among Women Who Elected Cesarean Section or a Trial of Labor after a Previous Cesarean Section.
The left-hand panel shows overall morbidity; the center panel, major complications; and the right-hand panel, minor complications.
Of the 3249 women who underwent a trial of labor, 1962 (60.4percent) had vaginal deliveries (Table 3). Women 35 years oldor older were more likely than others to require a cesareansection after a trial of labor. Women who had had one previousvaginal delivery were 3.3 times as likely as women who had hadonly a cesarean section to have a successful trial of labor;women with two or more previous vaginal deliveries were 5.0times as likely. A trial of labor was more likely to be successfulin women who attended prenatal classes and was more likely tofail if the infant weighed 4000 g or more or if the trial oflabor took place at a regional or community hospital. The infants'Apgar scores, the rates of admission to a neonatal intensivecare unit, and perinatal mortality were similar for the womenin whom the trial of labor did not result in delivery and forthose whose labor was successful.
Table 3. Characteristics of Pregnant Women Who Failed to Deliver Vaginally after a Trial of Labor and Those Who Delivered Vaginally after a Trial of Labor, in Nova Scotia, from 1986 through 1992.
Major and minor complications were more likely to occur in womenwho required a second cesarean section after a failed trialof labor than if the trial of labor was successful (Table 4);92.5 percent of major complications in the trial-of-labor groupoccurred in women who did not deliver their babies after a trialof labor and who therefore required a second cesarean section.
Table 4. Morbidity in Pregnant Women Who Failed to Deliver Vaginally after a Trial of Labor and Those Who Delivered Successfully, in Nova Scotia, from 1986 through 1992.
Discussion
The most important issue regarding maternal well-being withrespect to a trial of labor after a previous cesarean sectionis whether a catastrophic complication, such as uterine rupture,will occur and lead to serious morbidity or death. Maternaldeath during labor and delivery, regardless of the method ofdelivery, is uncommon. In our study there were no maternal deaths,a finding similar to that reported by Flamm et al.10 and Rosenet al.14 Maternal morbidity, on the other hand, was not negligible.Most of the complications, however, were minor and were morelikely to occur in women undergoing an elective cesarean sectionthan in those undergoing a trial of labor; the findings of Flammet al.10 and Rosen et al.14 were similar. The frequency of uterinerupture in the trial-of-labor group (0.3 percent) was similarto that in other studies.15,16 The number of hysterectomies,a tragic complication for a woman of reproductive age, was similarin the two groups. Operative injuries contributed to both totaland major morbidity among women who chose a trial of labor aftera previous cesarean section.
Women for whom a trial of labor is unsuccessful and who thereforerequire a second cesarean section have the greatest morbidity.In our study, 63.6 percent of major complications and 28.4 percentof minor complications occurred in women who required cesareansection after an unsuccessful trial of labor. A maternal ageof 35 years or more, delivery at a community or regional hospital,a birth weight of 4000 g or more in the infant, and the absenceof a history of vaginal delivery were associated with an increasedrisk of cesarean section due to the failure of a trial of labor.Although a trial of labor ends in vaginal delivery in 60 to80 percent of women who attempt it after a previous cesareansection,8,9,10,11,12 it is a great challenge to identify thewomen who are most likely to have a successful trial of labor.Recently, researchers have tried to predict the likelihood ofsuccess or failure with a trial of labor after a previous cesareansection.17,18,19 Previous dysfunctional labor, no prior vaginaldelivery, an abnormal fetal-heart-rate tracing, induction oflabor,17 fetal–pelvic disproportion,18 and fetal growthabnormalities19 all increased the likelihood that a trial oflabor would be unsuccessful.
Because some outcomes associated with a trial of labor aftera previous cesarean section are rare, we used population-baseddata to generate estimates of the risk of complications anddeath. However, our study is limited by possible selection biasand a possible lack of generalizability. Because the women wereallowed to choose between a trial of labor and an elective secondcesarean section, selection bias could have altered our estimatesof risk. The results of our study may also not be generalizableto other groups of women, since the management of a trial oflabor after a previous cesarean section in Canada may be differentfrom standard practice in other parts of the world. Finally,although neonatal outcomes in the two groups were similar, follow-upinformation about the infants was not available.
For a woman who has had a previous low transverse cesarean section,a choice must be made between a trial of labor and an electivesecond cesarean section. In this study, the risk of major complicationswas greater for women who chose a trial of labor than for thosewho chose a second cesarean section. This was so because therate of cesarean section in the women who attempted a trialof labor was 40 percent, and major complications were substantiallymore frequent than for women who had a second cesarean sectionwithout a previous trial of labor. This increased risk morethan offset the decreased risks associated with delivery inthe 60 percent of women in the same group whose trial of laborwas successful.
Clearly, the way to decrease the overall risk entailed by atrial of labor (including the risk of major complications) isby selecting women who have a high probability (perhaps morethan 80 percent) of delivering their babies vaginally. In thisstudy, women were more likely to have a successful trial oflabor if they were under 35 years of age, if the child's birthweight was less than 4000 g, and if they delivered in a tertiarycare hospital. However, there is as yet no confirmed methodof predicting the likelihood that a trial of labor will leadto vaginal delivery for a patient with a previous low transversecesarean section.
Source Information
From the Departments of Obstetrics and Gynecology (M.J.M., E.R.L., W.A.B.) and Epidemiology (M.J.M., A.F.O.), School of Medicine, University of North Carolina, Chapel Hill; and Dalhousie University, Halifax, N.S., Canada (E.R.L.).
Address reprint requests to Dr. McMahon at the Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, CB 7570, 214 MacNider Bldg., Chapel Hill, NC 27599-7570.
References
Rates of cesarean delivery -- United States, 1991. MMWR Morb Mortal Wkly Rep 1993;42:285-289. [Medline]
Eskew PN Jr, Saywell RM Jr, Zollinger TW, Erner BK, Oser TL. Trends in the frequency of cesarean delivery: a 21-year experience, 1970-1990. J Reprod Med 1994;39:809-817. [Medline]
Taffel SM, Placek PJ, Kosary CL. U.S. cesarean section rates 1990: an update. Birth 1992;19:21-22. [Medline]
Taffel SM, Placek PJ, Moien M, Kosary CL. 1989 U.S. cesarean section rate steadies -- VBAC rate rises to nearly one in five. Birth 1991;18:73-77. [Medline]
Soliman SRH, Burrows RF. Cesarean section: analysis of the experience before and after the National Consensus Conference on Aspects of Cesarean Birth. Can Med Assoc J 1993;148:1315-1320. [Abstract]
National Institutes of Health. Cesarean childbirth. Washington, D.C.: Government Printing Office, 1981:351-74. (NIH publication no. 82-2067.)
Indications for cesarean section: final statement of the panel of the National Consensus Conference on Aspects of Cesarean Birth. Can Med Assoc J 1986;134:1348-1352. [Medline]
Miller DA, Diaz FG, Paul RH. Vaginal birth after cesarean: a 10-year experience. Obstet Gynecol 1994;84:255-258. [Free Full Text]
Cowan RK, Kinch RAH, Ellis B, Anderson R. Trial of labor following cesarean delivery. Obstet Gynecol 1994;83:933-936. [Medline]
Flamm BL, Goings JR, Liu Y, Wolde-Tsadik G. Elective repeat cesarean delivery versus trial of labor: a prospective multicenter study. Obstet Gynecol 1994;83:927-932. [Medline]
Flamm BL, Newman LA, Thomas SJ, Fallon D, Yoshida MM. Vaginal birth after cesarean delivery: results of a 5-year multicenter collaborative study. Obstet Gynecol 1990;76:750-754. [Medline]
Rosen MG, Dickinson JC. Vaginal birth after cesarean: a meta-analysis of indicators for success. Obstet Gynecol 1990;76:865-869. [Medline]
Paul RH, Phelan JP, Yeh SY. Trial of labor in the patient with a prior cesarean birth. Am J Obstet Gynecol 1985;151:297-304. [Medline]
Rosen MG, Dickinson JC, Westhoff CL. Vaginal birth after cesarean: a meta-analysis of morbidity and mortality. Obstet Gynecol 1991;77:465-470. [Free Full Text]
Gellman E, Goldstein MS, Kaplan S, Shapiro WJ. Vaginal delivery after cesarean section: experience in private practice. JAMA 1983;249:2935-2937. [Abstract]
Troyer LR, Parisi VM. Obstetric parameters affecting success in a trial of labor: designation of a scoring system. Am J Obstet Gynecol 1992;167:1099-1104. [Medline]
Thurnau GR, Scates DH, Morgan MA. The fetal-pelvic index: a method of identifying fetal-pelvic disproportion in women attempting vaginal birth after previous cesarean delivery. Am J Obstet Gynecol 1991;165:353-358. [Medline]
Weinstein DW, Benshushan A, Tanos V, Zilberstein R, Rojansky N. Predictive score for vaginal birth after cesarean section. Am J Obstet Gynecol 1996;174:192-198. [CrossRef][Medline]
Chang, J. J., Stamilio, D. M., Macones, G. A.
(2008). Effect of Hospital Volume on Maternal Outcomes in Women with Prior Cesarean Delivery Undergoing Trial of Labor. Am J Epidemiol
167: 711-718
[Abstract][Full Text]
Cahill, A. G., Stamilio, D. M., Odibo, A. O., Peipert, J., Stevens, E., Macones, G. A.
(2008). Racial Disparity in the Success and Complications of Vaginal Birth After Cesarean Delivery. Obstet Gynecol
111: 654-658
[Abstract][Full Text]
Hernandez-Diaz, S., Van Marter, L. J., Werler, M. M., Louik, C., Mitchell, A. A.
(2007). Risk Factors for Persistent Pulmonary Hypertension of the Newborn. Pediatrics
120: e272-e282
[Abstract][Full Text]
Srinivas, S. K., Stamilio, D. M., Stevens, E. J., Odibo, A. O., Peipert, J. F., Macones, G. A.
(2007). Predicting Failure of a Vaginal Birth Attempt After Cesarean Delivery. Obstet Gynecol
109: 800-805
[Abstract][Full Text]
Visco, A. G., Viswanathan, M., Lohr, K. N., Wechter, M. E., Gartlehner, G., Wu, J. M., Palmieri, R., Funk, M. J., Lux, L., Swinson, T., Hartmann, K.
(2006). Cesarean Delivery on Maternal Request: Maternal and Neonatal Outcomes. Obstet Gynecol
108: 1517-1529
[Abstract][Full Text]
Allen, V. M., O'Connell, C. M., Baskett, T. F.
(2006). Cumulative economic implications of initial method of delivery.. Obstet Gynecol
108: 549-555
[Abstract][Full Text]
Allen, V. M., O'Connell, C. M., Baskett, T. F.
(2006). Maternal Morbidity Associated With Cesarean Delivery Without Labor Compared With Induction of Labor at Term. Obstet Gynecol
108: 286-294
[Abstract][Full Text]
Agnew, G., Turner, M.
(2006). Can a 29% Cesarean Delivery Rate Possibly Be Justified?. Obstet Gynecol
108: 452-452
[Full Text]
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]
Hibbard, J. U., Gilbert, S., Landon, M. B., Hauth, J. C., Leveno, K. J., Spong, C. Y., Varner, M. W., Caritis, S. N., Harper, M., Wapner, R. J., Sorokin, Y., Miodovnik, M., Carpenter, M., Peaceman, A. M., O'Sullivan, M. J., Sibai, B. M., Langer, O., Thorp, J. M., Ramin, S. M., Mercer, B. M., Gabbe, S. G., for the National Institute of Child Health and Hum,
(2006). Trial of Labor or Repeat Cesarean Delivery in Women With Morbid Obesity and Previous Cesarean Delivery.. Obstet Gynecol
108: 125-133
[Abstract][Full Text]
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]
Hoyert, D. L., Mathews, T.J., Menacker, F., Strobino, D. M., Guyer, B.
(2006). Annual Summary of Vital Statistics: 2004. Pediatrics
117: 168-183
[Abstract][Full Text]
Quinones, J. N., Stamilio, D. M., Pare, E., Peipert, J. F., Stevens, E., Macones, G. A.
(2005). The Effect of Prematurity on Vaginal Birth After Cesarean Delivery: Success and Maternal Morbidity. Obstet Gynecol
105: 519-524
[Abstract][Full Text]
Martin, J. A., Kochanek, K. D., Strobino, D. M., Guyer, B., MacDorman, M. F.
(2005). Annual Summary of Vital Statistics--2003. Pediatrics
115: 619-634
[Abstract][Full Text]
Landon, M. B., Hauth, J. C., Leveno, K. J., Spong, C. Y., Leindecker, S., Varner, M. W., Moawad, A. H., Caritis, S. N., Harper, M., Wapner, R. J., Sorokin, Y., Miodovnik, M., Carpenter, M., Peaceman, A. M., O'Sullivan, M. J., Sibai, B., Langer, O., Thorp, J. M., Ramin, S. M., Mercer, B. M., Gabbe, S. G., the National Institute of Child Health and Human D,
(2004). Maternal and Perinatal Outcomes Associated with a Trial of Labor after Prior Cesarean Delivery. NEJM
351: 2581-2589
[Abstract][Full Text]
Gyamfi, C., Juhasz, G., Gyamfi, P., Stone, J. L.
(2004). Increased Success of Trial of Labor After Previous Vaginal Birth After Cesarean. Obstet Gynecol
104: 715-719
[Abstract][Full Text]
Hendler, I., Bujold, E.
(2004). Effect of Prior Vaginal Delivery or Prior Vaginal Birth After Cesarean Delivery on Obstetric Outcomes in Women Undergoing Trial of Labor. Obstet Gynecol
104: 273-277
[Abstract][Full Text]
Guise, J.-M., McDonagh, M. S, Osterweil, P., Nygren, P., Chan, B. K S, Helfand, M.
(2004). Systematic review of the incidence and consequences of uterine rupture in women with previous caesarean section. BMJ
329: 19-
[Abstract][Full Text]
Hannah, M. E.
(2004). Planned elective cesarean section: A reasonable choice for some women?. CMAJ
170: 813-814
[Full Text]
Bujold, E., Blackwell, S. C., Gauthier, R. J.
(2004). Cervical Ripening With Transcervical Foley Catheter and the Risk of Uterine Rupture. Obstet Gynecol
103: 18-23
[Abstract][Full Text]
Joseph, K. S., Young, D. C., Dodds, L., O'Connell, C. M., Allen, V. M., Chandra, S., Allen, A. C.
(2003). Changes in Maternal Characteristics and Obstetric Practice and Recent Increases in Primary Cesarean Delivery. Obstet Gynecol
102: 791-800
[Abstract][Full Text]
Li, T., Rhoads, G. G., Smulian, J., Demissie, K., Wartenberg, D., Kruse, L.
(2003). Physician Cesarean Delivery Rates and Risk-Adjusted Perinatal Outcomes. Obstet Gynecol
101: 1204-1212
[Abstract][Full Text]
Kieser, K. E., Baskett, T. F.
(2002). A 10-Year Population-Based Study of Uterine Rupture. Obstet Gynecol
100: 749-753
[Abstract][Full Text]
Smith, G. C. S., Pell, J. P., Cameron, A. D., Dobbie, R.
(2002). Risk of Perinatal Death Associated With Labor After Previous Cesarean Delivery in Uncomplicated Term Pregnancies. JAMA
287: 2684-2690
[Abstract][Full Text]
Carbillon, L., Uzan, M., Batallan, A., Bujold, E., Mehta, S. H., Gauthier, R. J.
(2002). Should We Allow a Trial of Labor After a Previous Cesarean for Dystocia in the Second Stage of Labor?. Obstet Gynecol
99: 520-521
[Full Text]
Huang, W. H., Nakashima, D. K., Rumney, P. J., Keegan, K. A. Jr, Chan, K.
(2002). Interdelivery Interval and the Success of Vaginal Birth After Cesarean Delivery. Obstet Gynecol
99: 41-44
[Abstract][Full Text]
Bujold, E., Gauthier, R. J.
(2001). Should We Allow a Trial of Labor After a Previous Cesarean for Dystocia in the Second Stage of Labor?. Obstet Gynecol
98: 652-655
[Abstract][Full Text]
Melnikow, J., Romano, P., Gilbert, W. M., Schembri, M., Keyzer, J., Kravitz, R. L.
(2001). Vaginal Birth After Cesarean in California. Obstet Gynecol
98: 421-426
[Abstract][Full Text]
Lydon-Rochelle, M., Holt, V. L., Easterling, T. R., Martin, D. P.
(2001). Risk of Uterine Rupture during Labor among Women with a Prior Cesarean Delivery. NEJM
345: 3-8
[Abstract][Full Text]
CHUNG, A., MACARIO, A., EL-SAYED, Y. Y., RILEY, E. T., DUNCAN, B., DRUZIN, M. L.
(2001). Cost-Effectiveness of a Trial of Labor After Previous Cesarean. Obstet Gynecol
97: 932-941
[Abstract][Full Text]
LEVINE, E. M., GHAI, V., BARTON, J. J., STROM, C. M.
(2001). Mode of Delivery and Risk of Respiratory Diseases in Newborns. Obstet Gynecol
97: 439-442
[Abstract][Full Text]
Seinera, P., Farina, C., Todros, T.
(2000). Laparoscopic myomectomy and subsequent pregnancy: results in 54 patients. Hum Reprod
15: 1993-1996
[Abstract][Full Text]
GROBMAN, W. A., PEACEMAN, A. M., SOCOL, M. L.
(2000). Cost-Effectiveness of Elective Cesarean Delivery After One Prior Low Transverse Cesarean. Obstet Gynecol
95: 745-751
[Abstract][Full Text]
SHIPP, T. D., ZELOP, C. M., REPKE, J. T., COHEN, A., CAUGHEY, A. B., LIEBERMAN, E.
(1999). Intrapartum Uterine Rupture and Dehiscence in Patients With Prior Lower Uterine Segment Vertical and Transverse Incisions. Obstet Gynecol
94: 735-740
[Abstract][Full Text]
STAMILIO, D. M., MACONES, G. A.
(1999). Selection of Delivery Method in Pregnancies Complicated by Autoimmune Thrombocytopenia: A Decision Analysis. Obstet Gynecol
94: 41-47
[Abstract][Full Text]
SOCOL, M. L., PEACEMAN, A. M.
(1999). Vaginal Birth After Cesarean: An Appraisal of Fetal Risk. Obstet Gynecol
93: 674-679
[Abstract][Full Text]
RAGETH, J. C., JUZI, C., GROSSENBACHER, H.
(1999). Delivery After Previous Cesarean: A Risk Evaluation. Obstet Gynecol
93: 332-337
[Abstract][Full Text]
Sachs, B. P., Kobelin, C., Castro, M. A., Frigoletto, F.
(1999). The Risks of Lowering the Cesarean-Delivery Rate. NEJM
340: 54-57
[Full Text]
Paterson-Brown, S., Amu, O., Rajendran, S., Bolaji, I. I
(1998). Controversies in management: Should doctors perform an elective caesarean section on request? • Yes, as long as the woman is fully informed • Maternal choice alone should not determine method of delivery. BMJ
317: 462-465
[Full Text]
Greene, M. F., Roberts, D. J., Mark, E. J.
(1998). Case 9-1998- Cardiovascular Collapse after Vaginal Delivery in a Patient with a History of Cesarean Section. NEJM
338: 821-826
[Full Text]
Turner, M. J., McNally, O., Gardeil, F., Fruchter, O., Saad, A. H., Hale, R. W., McMahon, M. J., Luther, E. R., Bowes, W. A., Paul, R. H.
(1997). Trial of Labor Compared with an Elective Second Cesarean Section. NEJM
336: 658-659
[Full Text]
(1996). TRIAL OF LABOR VS. ANOTHER C-SECTION. JWatch General
1996: 1-1
[Full Text]
(1996). Trial of Labor vs. Another C-Section: How Safe Is Safe Enough?. JWatch Women's Health
1996: 3-3
[Full Text]
Paul, R. H.
(1996). Toward Fewer Cesarean Sections -- The Role of a Trial of Labor. NEJM
335: 735-736
[Full Text]
Guise, J.-M., Berlin, M., McDonagh, M., Osterweil, P., Chan, B., Helfand, M.
(1989). Safety of Vaginal Birth After Cesarean: A Systematic Review. Obstet Gynecol
103: 420-429
[Abstract][Full Text]
A correction has been published: N Engl J Med 1997;336(9):658.
