Vaginal delivery after previous cesarean section

The Authors evaluate the percentage of vaginal delivery after previous cesarean section, in a group of 57 patients. Results show that 34% of the patients delivered spontaneously, and when recurring causes are excluded the percentage rises to 39%. The Authors conclude that a careful monitoring of labour can prevent unnecessary cesarean section in patients who underwent previous surgical delivery.     

Vaginal delivery after previous cesarean section]

Data concerning frequency of cesarean section as well as frequency of vaginal delivery after cesarean section in Poznań region in years 1990-1991 were presented. During last years we observed significant increase of spontaneous deliveries after cesarean section. The indications for the previous cesarean section and the outcome of the present pregnancy are discussed.     

Vaginal delivery following previous cesarean section]

BACKGROUND AND AIM: The increased use of cesarean section (CS) over the past 30 years has raised a problem which has been much debated in obstetric practice: is it always necessary to repeat CS in women who have previously undergone cesarean section? The aim of this study was to establish whether women previously undergoing CS can start trial labour? METHODS: The authors examined 195 pregnant women who had previously undergone 1 or 2 CS. Medical history, clinical examination and maternal and fetal monitoring techniques were used to select the women who could start trial labour.     

Vaginal delivery following previous cesarean section in 1983

In 1983 the question whether or not to perform vaginal delivery following previous cesarean section is again presented to the obstetrical community. Data are presented on 778 patients managed during the decade January 1, 1973 to December 31, 1982. Four hundred seventy-six had scheduled repeat cesarean section on an elective basis. One hundred sixty-five experienced normal vaginal delivery. One hundred thirty-seven failed the attempt and were delivered by cesarean section. The group that delivered vaginally and scheduled elective cesarean section did well. However, in the failed attempt the problems were awesome regardless of indication or number of previous cesarean sections.     

Vaginal delivery after one caesarean section in Nigerian women.

A total of 120 Nigerian women at term pregnancy with one previous caesarean delivery were studied between June 1988 and May 1993. Elective caesarean section was performed in 3 (2.5%). Vaginal delivery was achieved in 101 (86.5%) of those allowed a trial of labour. Intrapartum caesarean section was done in 16 (13.7%) cases. Rupture of the uterus occurred in 3 cases (2.6%) with perinatal loss of 2 babies. There was no maternal mortality. There was no significant correlation between vaginal delivery and birth weight, gestational age or initial indication for the primary caesarean section. It is concluded that trial of labour is safe after a previous caesarean section in selected patients.     

Vaginal delivery after cesarean section

We retrospectively analyzed 194 pregnancies in women with a history of previous cesarean section (CS) who were offered a trial of labor. We offered every woman a trial of labor as long as she did not have a known previous classical scar. One hundred fifty-one women delivered vaginally (79%), 24 women had multiple uterine scars. Multiple gestations and breech presentation were not considered a sole indication to perform CS. Fetal and maternal morbidity are presented. We conclude that women with multiple previous CS scars can safely deliver vaginally as can women with unknown uterine scars, with careful intrapartum surveillance. Although our numbers of women with breech presentation and multiple gestations are small, in the absence of significant morbidity, we continue to allow these women to labor and deliver vaginally.     

Vaginal delivery after previous cesarean section in a rural West African hospital.

Two hundred twenty women with prior cesarean section were delivered at our institution between January 1987 and February 1990. Vaginal delivery was achieved in 111 (66%) of 169 patients given a trial of labor (TOL). Success of TOL correlated positively with the number of prior vaginal deliveries (P less than 0.05) and inversely with the number of prior cesarean sections (P less than 0.005). Maternal and fetal outcome were not significantly different between the TOL and non-TOL groups.     

Vaginal delivery after two previous cesarean sections]

We report on a patient, who, after two previous caesarean sections, normally delivered vaginally without complications. The obstetric approach to, or better, the management of a vaginal delivery after caesarean section, our experience in other vaginal deliveries after previous caesarean section is discussed. This case report shows that, after two previous caesarean sections, the next child can normally be delivered vaginally without complications.     

Vaginal hysterectomy in women with history of previous cesarean delivery

Objective: This study aimed to compare surgical outcomes with vaginal hysterectomy between women who have had ≥1 cesarean delivery and those who have not had a cesarean delivery. A secondary objective was to analyze the effect of previous vaginal birth on the complication rate of vaginal hysterectomy. Study Design: A retrospective analysis was performed on 221 women undergoing vaginal hysterectomy. Women were separated into those who had a history of previous cesarean deliveries (N = 35) and those who did not (N = 186). The groups were analyzed for the indications for surgery, perioperative hemoglobin loss, operative time, length of hospitalization, and complications. Trends in the complication rate for women in the previous cesarean group were also studied from the perspectives of numbers of previous cesarean deliveries and of vaginal delivery history. The 95% confidence intervals for the difference between proportions as well as P values for probability tests were calculated. P < .05 was considered significant. Results: Previous cesarean delivery experience did not affect hemoglobin change, hospital stay, or operative time among women undergoing vaginal hysterectomy. A total of 11.3% of women in the previous cesarean group had complications, versus 4.3% for the noncesarean group (P = .10, 95% confidence interval –3.8% to 18.0%). Complications did not increase with increasing number of previous cesarean deliveries (U = 1020.5, P = .28). Also, a trend toward fewer complications among patients with a history of cesarean delivery who had also had a vaginal delivery was demonstrated (U = 836, P = .05). Overall, women who were undergoing vaginal hysterectomy who had a history of ≥1 previous vaginal delivery had a complication rate of 3.2%, versus 17.6% for women who had not had a previous vaginal birth (P = .004, 95% confidence interval –27.5% to –1.3%). Conclusions: In this study women who had a history of previous cesarean delivery were not at higher risk for greater hemoglobin loss, longer hospital stay, more prolonged operative time, or significantly more perioperative complications when undergoing vaginal hysterectomy than were those women who had no history of previous cesarean delivery. Likewise, increasing the number of previous cesarean deliveries did not have an adverse impact on the complication rate. Previous vaginal delivery lowered the risk of complications from vaginal hysterectomy. (Am J Obstet Gynecol 1998;179:1473-8.)     

Vaginal delivery after cesarean section: a five-year study

All pregnancies that were complicated by a previous cesarean section were reviewed for a five-year period from 1978 to 1982. Of 799 such pregnancies, 216 underwent a trial of labor, and 66% experienced successful vaginal delivery. When the primary cesarean section was for cephalopelvic disproportion, 54% delivered vaginally, 75% breech, and 70% for fetal distress or other nonrepeating indications. There was no evidence of uterine scar disruption in the vaginally delivered group. Vaginal delivery after previous cesarean section can be a safe alternative for carefully selected patients cared for in the proper environment.     

Vaginal delivery after cesarean section in women with unknown types of uterine scar

Documentation of a prior cesarean and the type of uterine scar has been used as one criterion for permitting patients a trial of labor. In a highly mobile patient population such as ours, these medical facts are often difficult or impossible to obtain. As a result, we retrospectively examined the performance of patients with unknown types of cesarean scar and found no difference between them and a similar population with documented low cervical scars. Although obtaining an old record is useful, its absence probably should not interdict a trial of labor in a patient who desires to attempt vaginal delivery.     

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'.