Obstetrics & Gynecology

Skip Navigation LinksHome > February 2014 - Volume 123 - Issue 2, PART 1 > Safety of Trial of Labor After Cesarean Delivery in Grandmul...
Obstetrics & Gynecology:
doi: 10.1097/AOG.0000000000000082
Contents: Original Research

Safety of Trial of Labor After Cesarean Delivery in Grandmultiparous Women

Hochler, Hila MD; Yaffe, Haim MD; Schwed, Philippe MD; Mankuta, David MD

Supplemental Author Material
Collapse Box


OBJECTIVE: To evaluate the risk of uterine rupture and other major labor complications in a trial of labor after cesarean delivery (TOLAC) in grandmultiparous women.

METHODS: A retrospective descriptive study of 64,345 births in three hospitals between the years 1999 and 2009. The study group included 1,922 deliveries of women in their sixth or higher birth with one previous cesarean delivery.

RESULTS: The risk for uterine rupture was 0.3% (six cases) (95% confidence interval [CI] 0.11–0.68); of these, two cases ended in hysterectomy. There were another four hysterectomies not attributable to uterine rupture (a total risk of 0.3%). Neither induction nor augmentation of labor increased the risk for uterine rupture. Trial of labor after cesarean delivery in the first labor after prior cesarean delivery conferred a higher risk for hysterectomy (1% compared with 0.1%; P=.019). In the presence of shoulder dystocia (n=20), the risk of uterine rupture was 10% (two cases) compared with 0.2% when shoulder dystocia did not occur (P=.002; odds ratio 52.7, 95% CI 9–306).

CONCLUSION: Grandmultiparous women with one previous cesarean delivery can be offered TOLAC. Labor induction is not contraindicated in such women.


© 2014 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.



Looking for ABOG articles? Visit our ABOG MOC II collection. The selected Green Journal articles are free through the end of the calendar year.


If you are an ACOG Fellow and have not logged in or registered to Obstetrics & Gynecology, please follow these step-by-step instructions to access journal content with your member subscription.

Article Tools


Article Level Metrics