Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery

Mark B Landon; John C Hauth; Kenneth J Leveno; Catherine Y Spong; Sharon Leindecker; Michael W Varner; Atef H Moawad; Steve N Caritis; Margaret Harper; Ronald J Wapner; Yoram Sorokin; Menachem Miodovnik; Marshall Carpenter; Alan M Peaceman; Mary Jo O'Sullivan; Baha Sibai; Oded Langer; John M Thorp; Susan M Ramin; Brian M Mercer; Steven G Gabbe

doi:10.1056/NEJMoa040405

Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery

Landon MB, Hauth JC, Leveno KJ, Spong CY, Leindecker S, Varner MW, Moawad AH, Caritis SN, Harper M, Wapner RJ, Sorokin Y, Miodovnik M, Carpenter M, Peaceman AM, O'Sullivan MJ, Sibai B, Langer O, Thorp JM, Ramin SM, Mercer BM, Gabbe SG

Published December 16, 2004 New England Journal of Medicine

DOI 10.1056/NEJMoa040405 PMID 15598960

Abstract

Background

The proportion of women who attempt vaginal delivery after prior cesarean delivery has decreased largely because of concern about safety. The absolute and relative risks associated with a trial of labor in women with a history of cesarean delivery, as compared with elective repeated cesarean delivery without labor, are uncertain.

Methods

We conducted a prospective four-year observational study of all women with a singleton gestation and a prior cesarean delivery at 19 academic medical centers. Maternal and perinatal outcomes were compared between women who underwent a trial of labor and women who had an elective repeated cesarean delivery without labor.

Results

Vaginal delivery was attempted by 17,898 women, and 15,801 women underwent elective repeated cesarean delivery without labor. Symptomatic uterine rupture occurred in 124 women who underwent a trial of labor (0.7 percent). Hypoxic-ischemic encephalopathy occurred in no infants whose mothers underwent elective repeated cesarean delivery and in 12 infants born at term whose mothers underwent a trial of labor (P<0.001). Seven of these cases of hypoxic-ischemic encephalopathy followed uterine rupture (absolute risk, 0.46 per 1000 women at term undergoing a trial of labor), including two neonatal deaths. The rate of endometritis was higher in women undergoing a trial of labor than in women undergoing repeated elective cesarean delivery (2.9 percent vs. 1.8 percent), as was the rate of blood transfusion (1.7 percent vs. 1.0 percent). The frequency of hysterectomy and of maternal death did not differ significantly between groups (0.2 percent vs. 0.3 percent, and 0.02 percent vs. 0.04 percent, respectively).

Conclusions

A trial of labor after prior cesarean delivery is associated with a greater perinatal risk than is elective repeated cesarean delivery without labor, although absolute risks are low. This information is relevant for counseling women about their choices after a cesarean section. Copyright 2004 Massachusetts Medical Society.

Topics

Birth and Delivery Cesarean Birth Vaginal Birth After Cesarean

Birth and Delivery › Cesarean Birth › Vaginal Birth After Cesarean

Mark B Landon, John C Hauth, Kenneth J Leveno, Catherine Y Spong, Sharon Leindecker, Michael W Varner, Atef H Moawad, Steve N Caritis, Margaret Harper, Ronald J Wapner, Yoram Sorokin, Menachem Miodovnik, Marshall Carpenter, Alan M Peaceman, Mary Jo O'Sullivan, Baha Sibai, Oded Langer, John M Thorp, Susan M Ramin, Brian M Mercer, Steven G Gabbe

M Landon, Jack Hauth, J Hauth, Ken Leveno, K Leveno, Cathy Spong, Kate Spong, C Spong, S Leindecker, Mike Varner, M Varner, A Moawad, Stephen Caritis, Steven Caritis, S Caritis, Maggie Harper, Peggy Harper, M Harper, Ron Wapner, R Wapner, Y Sorokin, M Miodovnik, M Carpenter, A Peaceman, M O'Sullivan, B Sibai, O Langer, Jack Thorp, J Thorp, Sue Ramin, S Ramin, B Mercer, Steve Gabbe, S Gabbe

PMID 15598960 15598960 DOI 10.1056/NEJMoa040405 10.1056/NEJMoa040405 Landon et al. 2004, Landon 2004

Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery

Abstract

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