TRIAL OF LABOR IN PATIENTS WITH A PREVIOUS LOWER UTERINE CESAREAN-SECTION

OBJECTIVE: Our purpose was to determine the efficacy and safety of a t rial of labor in patients previously delivered at least once by a lowe r uterine vertical cesarean section. STUDY DESIGN: A retrospective rev iew was performed at a single tertiary perinatal center, The Universit y of Florida Health Science Center, Jacksonville. The medical records of all patients with a previous low vertical cesarean section who unde rwent a trial of labor during a 72-month period from January 1988 unti l December 1993 were reviewed. The medical records of the next two pat ients who did not have a prior uterine incision admitted to labor and delivery after the index case served as the controls. The duration and outcome of labor, including mode of delivery, maternal and perinatal morbidity, and birth trauma were evaluated. RESULTS: Of 77 patients wi th a previous low vertical cesarean incision, 11 (14.3%) had a repeat operation compared with 14 of 154 patients (9.0%) in the no previous c esarean section group (not significant). No differences were noted in the incidences of operative vaginal deliveries or prolonged duration o f the first or second stages of labor, or in the rate or maximum dose of oxytocin infusion between the two groups. One patient in the previo us cesarean section group had uterine rupture. The incidence of umbili cal artery pH less than or equal to 7.20 was similar. No difference in the number of infants with 1- or 5-minute Apgar scores less than or e qual to 7 was noted. CONCLUSION: A trial of labor in women with previo us low vertical cesarean sections results in an acceptable rate of vag inal delivery and appears safe for both mother and fetus.