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TRIAL OF LABOR VS. ANOTHER C-SECTION.

More women with a prior cesarean section are seeking to give birth vaginally, and the practice has been encouraged by statements from the American College of Obstetrics and Gynecology. However, controversy remains about its safety, and resolving it is critical as we seek to reduce use of C-section and ensure quality of care. This population-based study of 6138 Nova Scotian women compared the outcomes of trial of labor versus elective C-section in deliveries from 1986 through 1992.

All the women had one prior C-section and no contraindications to a trial of labor. The maternal morbidity rate was 8.1 percent overall: 1.3 percent of women had major complications (hysterectomy, uterine rupture, or operative injury) and 6.9 percent had minor complications (fever, blood transfusion, or abdominal wound infection). Complication rates were similar for trial-of-labor and C- section, but rates of major complications differed: 1.6 vs. 0.8 percent. This included 10 vs. 1 uterine ruptures, respectively. Of the 3249 women who had a trial of labor, 60 percent had successful vaginal deliveries. Success was most likely for women under age 35 with a previous vaginal delivery. No women died, and there were no differences in neonatal outcomes.

Comment: This study, involving hospitals ranging from community to tertiary-care facilities, is useful in confirming a relatively low rate of major complications of trial of labor after C-section. While major complications were more common among women who failed their trial of labor, a woman and her physician can weigh this risk against the benefits of avoiding major surgery, which are realized by the majority of women attempting a vaginal birth. --Wendy Levinson, MD, Professor of Medicine, Legacy Good Samaritan Hospital and Medical Center, Portland.

Published in Journal Watch General Medicine October 4, 1996

Citation(s):

McMahon MJ et al. Comparison of a trial of labor with an elective second cesarean section. N Engl J Med 1996 Sep 5 335 689-695.

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