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Trial of labor in the patient with a prior cesarean birth

  • Richard H. Paul
    Correspondence
    Reprint requests: Richard H. Paul, M.D., Women's Hospital, Room 5K40, 1240 North Mission Road, Los Angeles, CA 90033.
    Affiliations
    Department of Obstetrics and Gynecology, University of Southern California School of Medicine, Los Angeles, California, USA

    Women's Hospital, Los Angeles County/University of Southern California Medical Center, Los Angeles, California, USA.
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  • Jeffrey P. Phelan
    Affiliations
    Department of Obstetrics and Gynecology, University of Southern California School of Medicine, Los Angeles, California, USA

    Women's Hospital, Los Angeles County/University of Southern California Medical Center, Los Angeles, California, USA.
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  • Sze-ya Yeh
    Affiliations
    Department of Obstetrics and Gynecology, University of Southern California School of Medicine, Los Angeles, California, USA

    Women's Hospital, Los Angeles County/University of Southern California Medical Center, Los Angeles, California, USA.
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      Abstract

      The increasing incidence of cesarean birth has become quite controversial. The practice of deliverying virtually all women with a prior cesarean section by repeat cesarean section is open to debate. In a large institutional practice, with rapid availability of all support services, selective attempts to deliver women vaginally, after a prior cesarean section, is appealing. A prospective 1-year study on all patients with a prior cesarean delivery commenced July 1, 1982. There were 1209 patients, of whom 751 (62%) underwent a trial of labor and 614 (82%) achieved vaginal delivery. There was no maternal mortality or perinatal mortality attributed to the trial of labor process. Oxytocin usage occurred in 38% of this population. The incidence of uterine rupture and scar dehiscence was similar in the various study subgroups. The overall group of women undergoing a trial of labor had significantly fewer postpartum complications and shorter hospital stays.

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