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November 17, 2025International Journal of Gynecology & ObstetricsOpen Access

Maternal morbidity following a trial of labor after cesarean birth: A scoping review of operative vaginal birth compared with cesarean birth in the second stage of labor

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Authors

IOIrina OlteanVHVanessa HébertGMGiulia M. Muraca

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Overview

Scoping review finds distinct maternal morbidity patterns between operative vaginal and cesarean birth during labor after cesarean, highlighting high risk of bias across current evidence.

Key Points

  • To summarize the available clinical evidence and methodological quality concerning maternal morbidity between operative vaginal birth and second-stage cesarean birth during a trial of labor after cesarean.
  • Searched OVID MEDLINE, EMBASE, and Web of Science from 1950 to August 8, 2023.
  • Identified observational and experimental studies comparing operative vaginal birth (forceps or vacuum) with cesarean birth in the second stage of labor among individuals undergoing a trial of labor after cesarean.
  • Five cohort studies conducted across the USA, Israel, and Australia were included, all assessed as having a high risk of bias.
  • Second-stage cesarean birth had higher rates of surgical injury (9/87, 10.3% vs. 19/788, 2.4%), cystotomy (12/486, 2.5% vs. 4/743, 0.5%), and ureter injury (1/486, 0.2% vs. 1/743, 0.1%), alongside elevated rates of endometritis and wound complications compared with operative vaginal birth.
  • Operative vaginal birth demonstrated higher overall rates of composite maternal morbidity, leaving optimal intervention strategies uncertain.

Cite This Study

Oltean et al. (2025) studied this question.

synapsesocial.com/papers/6a9b102e1ddfc0236c0942e9https://doi.org/10.1002/ijgo.70668
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Maternal morbidity following a trial of labor after cesarean birth: A scoping review of operative vaginal birth compared with cesarean birth in the second stage of labor2025
  2. 2Trial of Labor After Cesarean and Vaginal Birth After Cesarean: A Systematic Review and Meta-Analysis of Maternal and Neonatal Outcomes2026
  3. 3Maternal and perinatal outcome in trial of labour after caesarean at tertiary care hospital: a prospective observational study2020 · 1 citations
  4. 4Nine years' experience of trial of labor after two previous cesarean sections at a tertiary hospital – A retrospective cohort study2026
  5. 5Maternal and neonatal outcomes of forceps delivery in women undergoing trial of labor after cesarean2026