Delivery for women with a previous cesarean: guidelines for clinical practice from the French College of Gynecologists and Obstetricians (CNGOF) |
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| Authors: | Loï c Sentilhes,Christophe Vayssiè re,Gael Beucher,Catherine Deneux-Tharaux,Philippe Deruelle,Pierre Diemunsch,Denis Gallot,Jean-Baptiste Haumonté ,Sonia Heimann,Gilles Kayem,Emmanuel Lopez,Olivier Parant,Thomas Schmitz,Yann Sellier,Patrick Rozenberg,Claude d&rsquo Ercole |
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| Affiliation: | 1. Service de Gynécologie-Obstétrique, CHU Angers, 49933 Angers, France;2. Service de Gynécologie-Obstétrique, Hôpital Paule de Viguier, CHU Toulouse, 31059 Toulouse, France;3. UMR 1027 Inserm Université Toulouse III «Epidémiologie Périnatale et handicap de l’enfant, Santé des adolescents», 31000 Toulouse, France;4. Service de Gynécologie-Obstétrique, CHU Caen, 14033 Caen, France;5. INSERM U953 «Recherches épidémiologiques en santé périnatale, santé des femmes et des enfants», UPMC, Maternité de Port-Royal, 75014 Paris, France;6. Service de Gynécologie-Obstétrique, CHU Lille, 59037 Lille, France;g EA 4489 «Environnement périnatal et croissance», PRES Lille-Nord-de-France, Lille, France;h Service d’Anesthesie-Réanimation, CHU d’Hautepierre, 67098 Strasbourg, France;i Service de Gynécologie-Obstétrique, CHU Estaing, 63003 Clermont-Ferrand, France;j R2D2-EA7281, Université d’Auvergne, 63000 Clermont-Ferrand, France;k Service de Gynécologie-Obstétrique, CHU Marseille, Hôpital Nord, AP-HM, 13015 Marseille, France;l Association d’usagers «Césarine», Paris, France;m Service de Gynécologie-Obstétrique, Hôpital Louis-Mourier, AP-HP, 92701 Colombes, France;n Service de Médecine Néonatale de Port-Royal, Groupe Hospitalier Cochin, Hôtel-Dieu, AP-HP, 75014 Paris, France;o Service de Gynécologie-Obstétrique, Hôpital de Robert-Debré, AP-HP, 75019 Paris, France;p Service de Gynécologie-Obstétrique, AP-HP Hôpital Necker – Enfants Malades, 75743 Paris, France;q Service de Gynécologie-Obstétrique, Centre Hospitalier Inter-Communal (CHI) de Poissy, 78300 Poissy, France |
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| Abstract: | The primary cause of uterine scars is a previous cesarean. In women with a previous cesarean, the risks of maternal complications are rare and similar after a trial of labor after cesarean (TOLAC) and after an elective repeat cesarean delivery (ERCD), but the risk of uterine rupture is higher with TOLAC (level of evidence [LE]2). Maternal morbidity in women with previous cesareans is higher when TOLAC fails than when it leads to successful vaginal delivery (LE2). Although maternal morbidity increases progressively with the number of ERCD, maternal morbidity of TOLAC decreases with the number of successful previous TOLAC (LE2). The risk-benefit ratio considering the risks of short- and long-term maternal complications is favorable to TOLAC in most cases (LE3). |
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| Keywords: | ERCD, elective repeat cesarean delivery LE, level of evidence TOLAC, trial of labor after cesarean VBAC, vaginal birth after cesarean |
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