Key result
Trial of labor after two previous cesareans had an 86.2% success rate and a higher uterine rupture rate than elective repeat cesarean (0.6% vs 0.1%, p=0.04), with similar severe maternal morbidities.
Why the study?
Does trial of labor after two previous cesarean deliveries improve maternal and neonatal outcomes compared to elective third repeat cesarean delivery in parturients with two previous cesareans?
Population
2,719 parturients with two previous cesarean deliveries
Comparison
Trial of labor after two previous cesarean… vs Elective third repeat cesarean delivery
Design
Cohort
Authors
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TOL after two CDs may be reasonable under strict protocols given comparable adjusted outcomes; leaves open need for RCTs to guide practice.
Cohort (n=2,719)
No
Does trial of labor after two previous cesarean deliveries improve maternal and neonatal outcomes compared to elective third repeat cesarean delivery in parturients with two previous cesareans?
Trial of labor after two previous cesarean deliveries is a reasonable alternative to elective repeat cesarean when following a strict protocol, despite a slightly higher risk of uterine rupture.
Rotem et al. (2020) conducted a cohort in Two previous cesarean deliveries (n=2,719). Trial of labor (TOL) vs. Elective third repeat cesarean delivery was evaluated on Composite of adverse maternal and neonatal outcomes. Trial of labor after two previous cesareans had an 86.2% success rate and a higher uterine rupture rate than elective repeat cesarean (0.6% vs 0.1%, p=0.04), with similar severe maternal morbidities.
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