Trial of Labor vs 2nd C-Section

A population-based longitudinal study was performed with a sample of 6138 women in Nova Scotia who previously had undergone cesarean section. Trial of labor was elected by 3249 women, whereas 2889 chose to undergo a second cesarean section. No maternal deaths were identified. The overall maternal morbidity was 8.1%; major complications (need for hysterectomy, uterine rupture, or operative injury) occurred in 1.3%, and minor complications (puerperal fever, blood transfusion, or abdominal wound infection) occurred in 6.9%. Although the overall rate of maternal complications did not differ significantly between women who chose trial of labor versus women who elected repeat cesarean section, major complications were nearly twice as likely among women undergoing a trial of labor (odds ratio 1.8, 95% confidence interval 1.1, 3.0). Apgar scores, admission to neonatal intensive care unit, and perinatal mortality were similar. Frequency of uterine rupture in the trial of labor group was 0.3%. Women whose trial of labor was unsuccessful and required a second cesarean section had the greatest risk for morbidity. This group of patients accounted for 63.6% of major complications and 28.4% of minor complications.