Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery

Mark B. Landon, John C. Hauth, Kenneth J. Leveno, Catherine Y. Spong, Sharon Leindecker, Michael W. Varner, Atef H. Moawad, Steve N. Caritis, Margaret Harper, Ronald J. Wapner, Yoram Sorokin, Menachem Miodovnik, Marshall Carpenter, Alan M. Peaceman, Mary Jo O'Sullivan, Baha Sibai, Oded Langer, John M. Thorp, Susan M. Ramin, Brian M. MercerSteven G. Gabbe

Research output: Contribution to journalArticle

802 Citations (Scopus)

Abstract

BACKGROUND: The proportion of women who attempt vaginal delivery after prior cesarean delivery has decreased largely because of concern about safety. The absolute and relative risks associated with a trial of labor in women with a history of cesarean delivery, as compared with elective repeated cesarean delivery without labor, are uncertain. METHODS: We conducted a prospective four-year observational study of all women with a singleton gestation and a prior cesarean delivery at 19 academic medical centers. Maternal and perinatal outcomes were compared between women who underwent a trial of labor and women who had an elective repeated cesarean delivery without labor. RESULTS: Vaginal delivery was attempted by 17,898 women, and 15,801 women underwent elective repeated cesarean delivery without labor. Symptomatic uterine rupture occurred in 124 women who underwent a trial of labor (0.7 percent). Hypoxic-ischemic encephalopathy occurred in no infants whose mothers underwent elective repeated cesarean delivery and in 12 infants born at term whose mothers underwent a trial of labor (P<0.001). Seven of these cases of hypoxic-ischemic encephalopathy followed uterine rupture (absolute risk, 0.46 per 1000 women at term undergoing a trial of labor), including two neonatal deaths. The rate of endometritis was higher in women undergoing a trial of labor than in women undergoing repeated elective cesarean delivery (2.9 percent vs. 1.8 percent), as was the rate of blood transfusion (1.7 percent vs. 1.0 percent). The frequency of hysterectomy and of maternal death did not differ significantly between groups (0.2 percent vs. 0.3 percent, and 0.02 percent vs. 0.04 percent, respectively). CONCLUSIONS: A trial of labor after prior cesarean delivery is associated with a greater perinatal risk than is elective repeated cesarean delivery without labor, although absolute risks are low. This information is relevant for counseling women about their choices after a cesarean section.

Original languageEnglish
Pages (from-to)2581-2589
Number of pages9
JournalNew England Journal of Medicine
Volume351
Issue number25
DOIs
StatePublished - Dec 16 2004
Externally publishedYes

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Trial of Labor
Mothers
Uterine Rupture
Brain Hypoxia-Ischemia
Endometritis
Maternal Death
Hysterectomy
Cesarean Section
Blood Transfusion
Observational Studies

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Landon, M. B., Hauth, J. C., Leveno, K. J., Spong, C. Y., Leindecker, S., Varner, M. W., ... Gabbe, S. G. (2004). Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. New England Journal of Medicine, 351(25), 2581-2589. https://doi.org/10.1056/NEJMoa040405

Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. / Landon, Mark B.; Hauth, John C.; Leveno, Kenneth J.; Spong, Catherine Y.; Leindecker, Sharon; Varner, Michael W.; Moawad, Atef H.; Caritis, Steve N.; Harper, Margaret; Wapner, Ronald J.; Sorokin, Yoram; Miodovnik, Menachem; Carpenter, Marshall; Peaceman, Alan M.; O'Sullivan, Mary Jo; Sibai, Baha; Langer, Oded; Thorp, John M.; Ramin, Susan M.; Mercer, Brian M.; Gabbe, Steven G.

In: New England Journal of Medicine, Vol. 351, No. 25, 16.12.2004, p. 2581-2589.

Research output: Contribution to journalArticle

Landon, MB, Hauth, JC, Leveno, KJ, Spong, CY, Leindecker, S, Varner, MW, Moawad, AH, Caritis, SN, Harper, M, Wapner, RJ, Sorokin, Y, Miodovnik, M, Carpenter, M, Peaceman, AM, O'Sullivan, MJ, Sibai, B, Langer, O, Thorp, JM, Ramin, SM, Mercer, BM & Gabbe, SG 2004, 'Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery', New England Journal of Medicine, vol. 351, no. 25, pp. 2581-2589. https://doi.org/10.1056/NEJMoa040405
Landon MB, Hauth JC, Leveno KJ, Spong CY, Leindecker S, Varner MW et al. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. New England Journal of Medicine. 2004 Dec 16;351(25):2581-2589. https://doi.org/10.1056/NEJMoa040405
Landon, Mark B. ; Hauth, John C. ; Leveno, Kenneth J. ; Spong, Catherine Y. ; Leindecker, Sharon ; Varner, Michael W. ; Moawad, Atef H. ; Caritis, Steve N. ; Harper, Margaret ; Wapner, Ronald J. ; Sorokin, Yoram ; Miodovnik, Menachem ; Carpenter, Marshall ; Peaceman, Alan M. ; O'Sullivan, Mary Jo ; Sibai, Baha ; Langer, Oded ; Thorp, John M. ; Ramin, Susan M. ; Mercer, Brian M. ; Gabbe, Steven G. / Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. In: New England Journal of Medicine. 2004 ; Vol. 351, No. 25. pp. 2581-2589.
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AU - Leindecker, Sharon

AU - Varner, Michael W.

AU - Moawad, Atef H.

AU - Caritis, Steve N.

AU - Harper, Margaret

AU - Wapner, Ronald J.

AU - Sorokin, Yoram

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AU - Sibai, Baha

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