Birth after previous cesarean delivery: Short-term maternal outcomes

Mona T. Lydon-Rochelle, Alison G. Cahill, Catherine Y. Spong

Research output: Contribution to journalReview article

24 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)249-257
Number of pages9
JournalSeminars in Perinatology
Volume34
Issue number4
DOIs
StatePublished - Aug 1 2010
Externally publishedYes

Keywords

  • Cesarean
  • NIH Consensus Development Conference
  • Pregnancy outcome
  • Repeat cesarean section
  • Trial of labor
  • Uterine rupture
  • Vaginal birth after cesarean

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

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