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Should We Allow a Trial of Labor After a Previous Cesarean for Dystocia in the Second Stage of Labor?

Bujold, Emmanuel MD; Gauthier, Robert J. MD

Original Research

OBJECTIVE To estimate the rate of successful vaginal birth including operative vaginal delivery in patients with a previous cesarean for cephalopelvic disproportion in the second stage of labor.

METHODS Data from all patients who underwent trial of labor after a previous cesarean between 1990 and 2000 at our tertiary care institution were analyzed. Medical records were reviewed and data collected for the following variables: indication for the previous cesarean, birth weight and cervical dilatation at previous cesarean delivery, as well as the mode of delivery (spontaneous, vacuum, forceps, cesarean) and the birth weight for the subsequent pregnancy. Pearson's χ2 test and one-way analysis of variance were used for statistical analyses.

RESULTS There were 2002 patients included in the study. Two hundred fourteen (11%) had their previous cesarean for dystocia in the second stage of labor, 654 (33%) for dystocia in the first stage of labor, and 1134 (57%) for other indications. The vaginal birth after cesarean success rate was 75.2% (P = .015 vs other indications), 65.6% (P < .001 vs other indications), and 82.5%, respectively. The rate of operative vaginal delivery was 15%, 12%, and 10% (P = .109).

CONCLUSION A trial of labor is reasonable in women whose previous cesarean was for dystocia in the second stage of labor. In this series, patients who underwent a trial of labor after a previous cesarean for dystocia in the second stage had 75.2% (95% confidence interval 69.5, 81.0) chance of achieving vaginal delivery.

Most patients who undertake a trial of labor after a previous cesarean for dystocia in the second stage achieve vaginal delivery.

Department of Obstetrics and Gynecology, Hôpital Ste-Justine and Université de Montréal, Montreal, Quebec, Canada

Address reprint requests to: Robert J. Gauthier, MD, Department of Obstetrics and Gynecology, Hôpital Ste-Justine and Université de Montréal, 3175 Côte Ste-Catherine, Montreal, Quebec, Canada H3T 1C5; E-mail: robert_gauthier@ssss.gouv.qc.ca.

We thank Camille Bujold and Dr. Amanda Skoll for their valuable contributions to this project, and M. Francois Harel and M. André Couturier for their assistance in statistical analysis.

Received January 23, 2001. Received in revised form April 19, 2001. Accepted May 24, 2001.

© 2001 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.