Comparison of a Trial of Labor with an Elective Second Cesarean Section Public Deposited

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  • Mcmahon, Michael J.
    • Affiliation: School of Medicine
  • Luther, Edwin R.
    • Affiliation: School of Medicine
    • Other Affiliation: Dalhousie University
  • Bowes Jr., Watson A.
    • Affiliation: School of Medicine
  • Olshan, Andrew F.
    • Affiliation: School of Medicine
Abstract
  • BACKGROUND: In an attempt to reduce the rate of cesarean section, obstetricians now offer a trial of labor to pregnant women who have had a previous cesarean section. Although a trial of labor is usually successful and is relatively safe, few studies have directly addressed the maternal and perinatal morbidity and mortality associated with this method of delivery. METHODS: We performed a population-based, longitudinal study of 6138 women in Nova Scotia who had previously undergone cesarean section and had delivered a singleton live infant in the period from 1986 through 1992. RESULTS: A total of 3249 women elected a trial of labor, and 2889 women chose to undergo a second cesarean section. There were no maternal deaths. The overall rate of maternal morbidity was 8.1 percent; 1.3 percent had major complications (a need for hysterectomy, uterine rupture, or operative injury) and 6.9 percent had minor complications (puerperal fever, a need for blood transfusion, or abdominal-wound infection). Although the overall rate of maternal complications did not differ significantly between women who chose a trial of labor and the women who elected cesarean section (odds ratio for the trial-of-labor group, 0.9; 95 percent confidence interval, 0.8 to 1.1), major complications were nearly twice as likely among women undergoing a trial of labor (odds ratio, 1.8; 95 percent confidence interval, 1.1 to 3.0). Apgar scores, admission to the neonatal intensive care unit, and perinatal mortality were similar among the infants whose mothers had a trial of labor and those whose mothers underwent elective cesarean section. CONCLUSION: Among pregnant women who have had a cesarean section, major maternal complications are almost twice as likely among those whose deliveries are managed with a trial of labor as among those who undergo an elective second cesarean section.
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Resource type
  • Article
Rights statement
  • In Copyright
Journal title
  • The New England Journal of Medicine
Journal volume
  • 335
Journal issue
  • 10
Page start
  • 689
Page end
  • 695
Language
  • English
ISSN
  • 0028-4793
  • 1533-4406
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