TRIAL OF LABOR AFTER CESAREAN DELIVERY WITH A LOWER-SEGMENT, VERTICALUTERINE INCISION - IS IT SAFE

OBJECTIVE: Our purpose was to assess maternal and perinatal outcomes a ssociated with a trial of labor and attempted vaginal birth after prio r low-segment vertical cesarean delivery. STUDY DESIGN: During a 10-ye ar period in a single tertiary hospital, all patients with a prior low -segment uterine incision (whether vertical or transverse) were consid ered candidates for a trial of labor in the absence of other contraind ications or patient refusal. Among the 1137 women who underwent tow-se gment vertical cesarean delivery, 262 were subsequently delivered of 3 22 live-born infants, and 174 (54%) of them were identified retrospect ively as having attempted vaginal birth. The maternal and perinatal ou tcomes of patients who did or did not undergo a trial of labor were an alyzed and compared. RESULTS: No significant differences between the t wo patient groups were observed regarding demographic characteristics, antepartum complications, gestational age at delivery (mean 37.4 week s), birth weight, and cord pH at delivery. Vaginal delivery was accomp lished successfully in 144 of 174 (83%) patients who underwent a trial of labor. Abdominal delivery was necessary for 17 mothers with labor disorders and 13 with suspected fetal distress. Postpartum hemorrhage occurred more often in the trial of labor group (7/174 [4.0%] vs 21/48 [1.4%, p not significant), but endometritis developed significantly m ore often in patients with elective repeat cesarean delivery (16.9% vs 6.3%, p = 0.006). Rupture of the few-segment vertical cesarean scar o ccurred in 2 patients during a trial of labor (1.1%) versus none in th e elective repeat cesarean group. Neither mother experienced fetal ext rusion or adverse maternal or fetal sequelae. Frequency of serious neo natal complications (8.1% vs 10%) and neonatal mortality (1.7% vs 2.0% ) were similar between groups. All neonatal deaths were a result of ex treme prematurity or congenital anomalies. CONCLUSIONS: Our experience indicates that a mother with a prior low-segment vertical cesarean de livery can undertake a trial of labor with relative maternal-perinatal safety. The likelihood of successful outcome and the incidence of com plications are comparable to those of published experience with a tria l of labor after a previous low-segment transverse incision.