Trial of labor after one previous cesarean delivery for multifetal gestation

Michael W. Varner*, Elizabeth Thom, Catherine Y. Spong, Mark B. Landon, Kenneth J. Leveno, Dwight J. Rouse, Atef H. Moawad, Hyagriv N. Simhan, Margaret Harper, Ronald J. Wapner, Yoram Sorokin, Menachem Miodovnik, Marshall Carpenter, Alan Peaceman, Mary J. O'Sullivan, Baha M. Sibai, Oded Langer, John M. Thorp, Susan M. Ramin, Brian M. Mercer

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

Abstract

OBJECTIVE: To estimate success rates and risks with a trial of labor after one previous cesarean delivery for multifetal gestation compared with one previous cesarean delivery for a singleton pregnancy. METHODS: Patients from the National Institute of Child Health and Human Development Maternal Fetal Medicine Units Network Cesarean Registry with one previous cesarean delivery and a current term singleton pregnancy were identified. Cases had one previous cesarean delivery for a multifetal pregnancy. Controls had one previous cesarean delivery for a singleton pregnancy. RESULTS: Of cases, 556 of 944 (58.9%) attempted a trial of labor. Of controls, 13,923 of 29,329 (47.5%) attempted a trial of labor. The trial of labor success rate was 85.6% among cases and 73.1% among controls (odds ratio 2.19, 95% confidence interval 1.72-2.78). Compared with trial of labor controls, cases had no statistically increased risk of transfusion, endometritis, intensive care unit admissions, uterine rupture, or perinatal complications. Cases in this analysis with a successful trial of labor were more likely to have previously had a successful vaginal birth after cesarean (37.1% compared with 14.1%, P<.001). CONCLUSION: Women with one previous cesarean delivery for a multifetal gestation have high trial of labor success rates and low complication rates.

Original languageEnglish (US)
Pages (from-to)814-819
Number of pages6
JournalObstetrics and gynecology
Volume110
Issue number4
DOIs
StatePublished - Oct 2007

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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