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  • Title: Comparison of maternal mortality and morbidity between trial of labor and elective cesarean section among women with previous cesarean delivery.
    Author: Wen SW, Rusen ID, Walker M, Liston R, Kramer MS, Baskett T, Heaman M, Liu S, Maternal Health Study Group, Canadian Perinatal Surveillance System.
    Journal: Am J Obstet Gynecol; 2004 Oct; 191(4):1263-9. PubMed ID: 15507951.
    Abstract:
    OBJECTIVE: This study was undertaken to assess the safety of trial of labor after previous cesarean delivery. STUDY DESIGN: Retrospective cohort study of 308,755 Canadian women with previous cesarean delivery between 1988 and 2000. Occurrences of in-hospital maternal death, uterine rupture, and other severe maternal morbidity were compared between women with a trial of labor and those with an elective cesarean section. RESULTS: Rates of uterine rupture (0.65%), transfusion (0.19%), and hysterectomy (0.10%) were significantly higher in the trial-of-labor group. Maternal in-hospital death rate, however, was lower in the trial-of-labor group (1.6 per 100,000) than in the elective cesarean section group (5.6 per 100,000). The association between trial of labor and uterine rupture was stronger in low volume (<500) than in high volume (> or =500 births per year) obstetric units. CONCLUSION: Trial of labor is associated with increased risk of uterine rupture, but elective cesarean section may increase the risk of maternal death.
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