Two or more cesarean sections - Elective repeat cesarean section or vaginal birth

Cesarian section rates have been steadily increasing over the Fast two deca des in most countries of the Western world. The review of the literature su ggests that a trial of labor in patients with more than one previous cesare an delivery is appropriate, and that these women should be treated no diffe rently from those who have had only one cesarean delivery. Obstetric management should be individualized after thorough patient counse ling. If women are carefully selected for a trial of labor and supervised c losely, the risk of serious complications can be minimized and a successful outcome achieved. Epidural anesthesia is safe, effective and justified. Si milarly, if oxytocin administration is considered medically necessary eithe r to augment or to induce labor, it should be given. It would appear from t he present data, that the use of prostaglandins for priming and induction o f labor is also safe and effective under consistent supervision. Rupture of the uterine scare is a rare but catastrophic complication (0-2,8%); fetal bradycardia may be the only diagnostic sign. Prompt intervention is necessa ry to minimize both maternal and neonatal complications. The maternal and fetal outcomes in women who have had multiple previous sec tions do not differ from those in women after ordinary cesarean section. At present there is no sufficiently predictive method to identify those women most likly to benefit from an elective repeat cesarean delivery.