Vaginal delivery after two or more previous caesarean sections: is trial of labour contraindicated?

Abstract

A retrospective study was conducted involving 308 patients with previous caesarean sections and current singleton pregnancy. All the women delivered at the University Teaching Hospital Zaria, after having been in established labour. The aim was to determine any significant maternal and fetal risk attributable to labour in patients with more than one previous caesarean which may mitigate against a trial of vaginal delivery. The study analysis involved a group of patients with one previous caesarean section compared with those with more than one (multiple) caesarean section who delivered vaginally or abdominally after having been in established labour. The results showed that there was no significant difference in maternal and perinatal mortality rates and perinatal morbidity rates between the two groups. The patients with multiple caesarean sections who failed to deliver vaginally had increased rates of postoperative pyrexia (18.7%), anaemia (23.4%) and blood transfusion (35.3%). The study showed that the risk of fatal outcome related to labour in patients with multiple caesarean sections was low and could be eliminated by careful patient selection and close intrapartum care. A positive review of policy towards a trial of vaginal delivery in multiple caesarean sections is therefore advocated in view of the advances in patient management in contemporary obstetric care. The gains in terms of patient compliance towards hospital care and supervised delivery will be considerable. A multicentre, prospective case-controlled trial will clearly define the risks attributable to this policy change.