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Obstetrics & Gynecology:
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Trial of Labor After Cesarean Delivery: Experience in the Non-University Level II Regional Hospital Setting.

HOLLAND, JOHN G. MD; DUPRE, ALLEN R. MD; BLAKE, PAMELA G. RN, MSN; MARTIN, RICK W. MD; MARTIN, JAMES N. Jr, MD

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Abstract

Objective: We sought to determine the extent to which vaginal birth after cesarean delivery was attempted since 1987 or 1988 in a representative sample of three regional level II hospitals in Mississippi.

Methods: The medical record department in each hospital identified all potential study subjects for this retrospective case series. One author abstracted relevant information from each medical record and entered it into a relational data base.

Results: Among 18,703 live births, 1574 patients had previous abdominal delivery (8.4%). Trial of labor was undertaken in 286 patients (18%), with an overall successful vaginal delivery rate of 71%. Although success rates for the three level II hospitals were similar (63-81%), utilization rates varied considerably (7-40%). One uterine dehiscence led to hysterectomy; otherwise, there were no serious perinatal complications or differences in measures of maternal morbidity, except for a higher incidence of endomyometritis with failed trial of labor (13 versus 3%). The only consistent differences observed between successful and unsuccessful trials in all groups were length of hospitalization and rate of cervical dilatation in active labor (1.4 versus 0.5 cm/hour).

Conclusion: Although each regional level II hospital successfully conducted trials of labor in patients with previous cesarean birth, there was considerable variation among sites regarding frequency of utilization, suggesting a strong influence of nonclinical patient-physician factors upon the decision-making process.

(C) 1992 The American College of Obstetricians and Gynecologists

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