Abstract
Objective: To study the outcome of offering a trial of labor to women with history of two previous cesarean sections (CS) after appropriate counseling
Design: Retrospective
Setting: Obstetric Unit at King Khalid University Hospital, Riyadh, Saudi Arabia, over a period of seven years (1993 - 1999)
Subjects: A total of 40 women with two previous CS requested a trial of labor
Intervention: Trial of labor despite having two previous CS based on specific predetermined criteria
Main Outcome Measure(s): (1) The rate of vaginal delivery, (2) The rate of repeat CS and (3) Neonatal outcome
Results: This group represents 8% of women with a history of two previous CS out of which 50% had primary CS and 25% had repeated CS in their previous pregnancies. Spontaneous labor occurred in 95% and augmentation in 45%. There was no uterine dehiscence or rupture in this study. There were five intrauterine deaths, six babies admitted to the NICU; four for prematurity and breech delivery and two for grunting. There was no birth asphyxia or neonatal death. Five of these cases are presented in detail.
Conclusion: The favorable outcome in this study shows that trial of labor can be safely offered to a selected group of women with two previous CS after proper counseling. This goal can be achieved without limiting childbirth options for women who sincerely wish to avoid multiple cesarean deliveries. Larger trials are needed in our community to support finding in this study.