The course of delivery after previous cesarean section

Of 249 women whose last pregnancy was terminated by a cesarean section, 57 (22.9%) were delivered again by a primary cesarean section. The other 192 (77.1%) were allowed to attempt vaginal birth. Of these, 151 (60.6%) were successful, and 41 (16.5%) underwent a secondary cesarean section. The percentage of successful vaginal births was correlated with the indication for the previous cesarean section. There was one case of incomplete uterine rupture. The maternal morbidity was lowest in the group who had a vaginal delivery. One child developed an Erb-Duchenne paralysis in addition to a shoulder dystocia. The condition of the vaginally delivered children was not different from the condition of the children born by a primary cesarean section. It is concluded that there are sufficient arguments for continuing the policy of 'once a cesarean section, trial of labor after selection'.