Objective: To determine whether the risk of cesarean for women who had tria
ls of labor after one prior cesarean differs from that of nulliparas overal
l and by indications for those cesareans.
Methods: We reviewed medical records of women who had trials of labor after
cesareans between July 1984 and June 1996, and of nulliparas who delivered
between December 1994 and August 1995. Cesarean rates for women with prior
cesareans were compared with the rates for nulliparas overall and by prior
cesarean indication (breech, failure to progress, nonreassuring fetal test
ing, or other). Lengths of labor for women who had repeat cesareans for fai
lure to progress in index pregnancies were compared by prior cesarean indic
ation.
Results: The cesarean rate was 28.7% (634 of 2207) for the prior cesarean g
roup and 13.5% (219 of 1617) for nulliparas (P = .001), and varied accordin
g to the prior cesarean indication (13.9%, 37.3%, 25.4%, and 24.8% for bree
ch, failure to progress, nonreassuring fetal testing, and other, respective
ly). Mean durations of labor in the index pregnancies for women who had ces
areans for failure to progress were 13.9, 11.5, 13.4, and 15.1 hours for br
eech, failure to progress, nonreassuring fetal testing, and other, respecti
vely.
Conclusion: Overall rates of cesareans were higher for women with one prior
cesarean than for nulliparas. Rates of cesareans after trials of labor wer
e related to the prior cesarean indications. Rates were highest for women w
hose prior cesareans were for failure to progress and lowest for women whos
e prior cesareans were for breech. The latter group had a rate that was ess
entially identical to that of nulliparas. Among women with cesareans for fa
ilure to progress in index pregnancies, lengths of labor were shorter for t
hose whose prior cesareans were for failure to progress than for those whos
e prior cesareans were for other indications, suggesting that physicians ma
y intervene earlier in these cases. (Obstet Gynecol 2000;95:913-6. (C) 2000
by The American College of Obstetricians and Gynecologists).