VAGINAL BIRTH AFTER CESAREAN - A 10-YEAR EXPERIENCE

Objective: To report the changing incidence of previous cesarean delivery, and the increasing use and success of a trial of labor and its effect on the repeat cesarean rate. Methods: Between 1983-1992, there were 164,815 deliveries at Los Angeles County + University of Southern California Women's Hospital, of which 17,322 (10.5%) were to women with at least one previous cesarean delivery. Data were gathered on an ongoing basis from delivery logs and patient charts. Results: Women with at least one previous cesarean accounted for 8.1% of all deliveries in 1983, increasing to 14.1% by 1992. Trial of labor was used in 80% of women with one previous cesarean, in 54% with two, and in 30% with three or more. The success rate was significantly higher with one previous cesarean (83%) than with two or more (75.3%). Furthermore, uterine rupture was three times more common with two or more previous cesareans. Compared to a policy of routine repeat cesarean, trial of labor yielded a 6.4% lower cesarean delivery rate. The majority of this benefit (5.5%) was derived by women with one previous cesarean. Among women undergoing a trial of labor, there were three rupture-related perinatal deaths and a single rupture-related maternal death. Conclusion: Substantial reduction in the cesarean rate is achieved safely and efficiently by encouraging a trial of labor in women with a single previous cesarean delivery.