Labor after previous cesarean: Influence of prior indication and parity

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).