COMPARISON OF A TRIAL OF LABOR WITH AN ELECTIVE 2ND CESAREAN-SECTION

Background in an attempt to reduce the rate of cesarean section, obste tricians now offer a trial of labor to pregnant women who have had a p revious cesarean section. Although a trial of labor is usually success ful and is relatively safe, few studies have directly addressed the ma ternal and perinatal morbidity and mortality associated with this meth od of delivery. Methods We performed a population-based, longitudinal study of 6138 women in Nova Scotia who had previously undergone cesare an section and had delivered a singleton live infant in the period fro m 1986 through 1992. Results A total of 3249 women elected a trial of labor, and 2889 women chose to undergo a second cesarean section. Ther e were no maternal deaths. The overall rate of maternal morbidity was 8.1 percent; 1.3 percent had major complications (a need for hysterect omy, uterine rupture, or operative injury) and 6.9 percent had minor c omplications (puerperal fever, a need for blood transfusion, or abdomi nal-wound infection). Although the overall rate of maternal complicati ons did not differ significantly between the women who chose a trial o f 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 undergo ing 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 u nit, and perinatal mortality were similar among the infants whose moth ers had a trial of labor and those whose mothers underwent elective ce sarean section. Conclusions Among pregnant women who have had a cesare an section, major maternal complications are almost twice as likely am ong those whose deliveries are managed with a trial of labor as among those who undergo an elective second cesarean section. (C) 1996, Massa chusetts Medical Society.