Am J Perinatol 2007; 24(8): 483-486
DOI: 10.1055/s-2007-986676
© Thieme Medical Publishers

The Outcome and Cumulative Morbidity Associated with the Second and Third Postcesarean Delivery

Ron Gonen1 , 2 , Shlomi Barak1 , 2 , Viki Nissenblat1 , 2 , Gonen Ohel1 , 2
  • 1Department of Obstetrics & Gynecology, Bnai Zion Medical Center, Haifa, Israel
  • 2Faculty of Medicine, Technion, Haifa, Israel
Further Information

Publication History

Publication Date:
12 September 2007 (online)

ABSTRACT

The purpose of this study was to compare the outcome and cumulative morbidity among women who delivered twice after a cesarean delivery (CD), and who underwent in the second delivery either a trial of labor (TOL) or planned cesarean delivery (PCD). Eligible women (N = 399) were divided into two groups based on first post-CD: a TOL (n = 304) or PCD (n = 95). Women attempting a TOL were successful in 70 and 75% in the first and second post-CD, respectively. All participants undergoing a PCD subsequently had a third PCD. The overall morbidity was 8.4 and 5.3% among PCD and TOL groups, respectively (p = 0.258). Women attempting a TOL after a previous CD had a 70 and 53% likelihood for at least one successful or two successful vaginal births in the two subsequent deliveries, respectively. No significant difference was documented between the groups regarding the cumulative morbidity.

REFERENCES

  • 1 Mozurkewich E L, Hutton E K. Elective repeat cesarean delivery versus trial of labor: a meta-analysis of the literature from 1989 to 1999.  Am J Obstet Gynecol. 2000;  183 1187-1197
  • 2 Lydon-Rochelle M, Holt V L, Easterling T R, Martin D P. Risk of uterine rupture during labor among women with prior cesarean delivery.  N Engl J Med. 2001;  345 3-8
  • 3 McMahon M J, Luther E R, Bowes W A, Olshan A F. Comparison of a trial of labor with an elective second cesarean section.  N Engl J Med. 1996;  335 689-695
  • 4 Landon M B, Hauth J C, Leveno K J et al.. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery.  N Engl J Med. 2004;  351 2581-2589
  • 5 Lynch C M, Kearney R, Turner M J. Maternal morbidity after elective repeat caesarean section after two or more previous procedures.  Eur J Obstet Gynecol Reprod Biol. 2003;  106 10-13
  • 6 Gilliam M, Rosenberg D, Davis F. The likelihood of placenta previa with greater number of cesarean deliveries and higher parity.  Obstet Gynecol. 2002;  99 976-980
  • 7 Ananth C V, Smulian J C, Vintzileos A M. The association of placenta previa with greater number of cesarean deliveries and abortion: a metaanalysis.  Am J Obstet Gynecol. 1997;  177 1071-1078
  • 8 Gielchinsky Y, Rojansky N, Fasouliotis S J, Ezra Y. Placenta accreta - summary of 10 years: a survey of 310 cases.  Placenta. 2002;  23 210-214
  • 9 Zorlu C G, Turan C, Isik A Z, Danişman N, Mungan T, Gökmen O. Emergency hysterectomy in modern obstetric practice: changing clinical perspective in time.  Acta Obstet Gynecol Scand. 1998;  77 186-190
  • 10 Rageth C J, Juzi C, Grossenbacher H. Delivery after previous cesarean: A risk evaluation.  Obstet Gynecol. 1999;  93 332-337
  • 11 Mankuta D, Leshno M M, Menasche M M, Brezis M M. Vaginal birth after cesarean section: Trial of labor or repeat cesarean section? A decision analysis.  Am J Obstet Gynecol. 2003;  189 714-719

Ron GonenM.D. 

Deputy Chairman, Department of Obstetrics & Gynecology, Director of Maternal-Fetal Medicine, Bnai Zion Medical Center

47 Golomb Street, Haifa, Israel

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