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Volume 335:689-695 September 5, 1996 Number 10 Next

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ABSTRACT

Background In an attempt to reduce the rate of cesarean section, obstetricians now offer a trial of labor to pregnant women who have had a previous cesarean section. Although a trial of labor is usually successful and is relatively safe, few studies have directly addressed the maternal and perinatal morbidity and mortality associated with this method of delivery.

Methods We performed a population-based, longitudinal study of 6138 women in Nova Scotia who had previously undergone cesarean section and had delivered a singleton live infant in the period from 1986 through 1992.

Results A total of 3249 women elected a trial of labor, and 2889 women chose to undergo a second cesarean section. There were no maternal deaths. The overall rate of maternal morbidity was 8.1 percent; 1.3 percent had major complications (a need for hysterectomy, uterine rupture, or operative injury) and 6.9 percent had minor complications (puerperal fever, a need for blood transfusion, or abdominal-wound infection). Although the overall rate of maternal complications did not differ significantly between the women who chose a trial of labor and the women who elected cesarean section (odds ratio for the trial-of-labor group, 0.9; 95 percent confidence interval, 0.8 to 1.1), major complications were nearly twice as likely among women undergoing a trial of labor (odds ratio, 1.8; 95 percent confidence interval, 1.1 to 3.0). Apgar scores, admission to the neonatal intensive care unit, and perinatal mortality were similar among the infants whose mothers had a trial of labor and those whose mothers underwent elective cesarean section.

Conclusions Among pregnant women who have had a cesarean section, major maternal complications are almost twice as likely among those whose deliveries are managed with a trial of labor as among those who undergo an elective second cesarean 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.

Full Text of this Article

Related Letters:

Trial of Labor Compared with an Elective Second Cesarean Section
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.
Extract | Full Text  
N Engl J Med 1997; 336:658-659, Feb 27, 1997. Correspondence

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