Abstract Introduction The global cesarean section (CS) rate has increased to 21.1% between 1990 and 2018. In Singapore, the annual CS rate has increased by ~ 0.6%, reaching an overall rate of 37.4%. Almost one‐third of all cesarean deliveries are performed for at least one previous CS. Women with two CSs are often denied a “trial of vaginal delivery” due to the increased risk of uterine scar rupture. This study aims to examine maternal and neonatal outcomes of women undergoing trials of labor following two CSs (TOLAC‐2). Material and Methods We conducted a retrospective observational study of women with singleton, term pregnancies in cephalic presentation who underwent TOLAC‐2 at the National University Hospital, Singapore, between September 2013 and June 2022. Data were obtained through a detailed review of electronic medical records. Results Among 898 women with two previous CSs, 7.0% (63/898) attempted TOLAC‐2, of whom 55.6% (35/63) achieved a successful vaginal birth (VBAC‐2). Successful TOLAC‐2 was associated with a significantly shorter duration of active labor (5.0 vs. 7.7 h, p = 0.013) and lower estimated blood loss (242mLs vs. 423mLs, p ≤ 0.001) compared with failed TOLAC‐2. There were no perinatal complications of uterine rupture, APGAR <7 at 5 minutes, meconium aspiration syndrome or hypoxic–ischemic encephalopathy. We observed a trend toward successful VBAC‐2 in women with a history of prior vaginal birth (74.6% vs. 48.9% p = 0.07). Conclusions In our cohort, more than half of the women attempting TOLAC‐2 at term achieved a successful vaginal birth without serious perinatal or maternal complications. TOLAC‐2 is a safe and reasonable option for appropriately selected women following adequate counseling, even in the absence of a prior vaginal delivery.
Lee et al. (Thu,) studied this question.