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. 1987 Jun 27;294(6588):1645–1647. doi: 10.1136/bmj.294.6588.1645

Delivery after caesarean section: review of 2176 consecutive cases.

B G Molloy, O Sheil, N M Duignan
PMCID: PMC1246822  PMID: 3113567

Abstract

A total of 2176 consecutive patients who had had one previous caesarean section were studied retrospectively. A repeat elective caesarean section was performed in 395 (18.2%). Labour started spontaneously in 1363 patients, 301 of whom were given oxytocin to accelerate inert labour, and was induced by amniotomy and infusion of oxytocin in 418 women; 1618 of these 1781 patients (90.8%) delivered vaginally. Patients who had had a previous vaginal delivery were more likely to deliver vaginally again. Those women in whom the initial caesarean section had been performed during labour before the cervix was 4 cm dilated were less likely to deliver vaginally than those who had progressed further in labour or those who had had an elective caesarean section. Similarly, those who received oxytocin to stimulate inert labour were more likely to require a repeat caesarean section than those who did not. The uterine scar ruptured in only eight (0.45%) of the 1781 patients allowed into labour. The risk of rupture of the scar was not increased by the use of oxytocin alone either to induce or to accelerate labour. The combination of oxytocin to accelerate labour and epidural analgesia to provide pain relief, however, was associated with an increased incidence of scar rupture. Labour may be safely allowed in women who have had a previous caesarean section, most of whom will deliver vaginally. Induction of labour does not increase the risk of either a repeat caesarean section or rupture of a uterine scar.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ALLAHBADIA N. K. Vaginal delivery following cesarean section. Am J Obstet Gynecol. 1963 Jan 15;85:241–249. doi: 10.1016/s0002-9378(16)35397-2. [DOI] [PubMed] [Google Scholar]
  2. COSGROVE R. A. Management of pregnancy and delivery following cesarean section. J Am Med Assoc. 1951 Mar 24;145(12):884–888. doi: 10.1001/jama.1951.02920300024005. [DOI] [PubMed] [Google Scholar]
  3. Case B. D., Corcoran R., Jeffcoate N., Randle G. H. Caesarean section and its place in modern obstetric practice. J Obstet Gynaecol Br Commonw. 1971 Mar;78(3):203–214. doi: 10.1111/j.1471-0528.1971.tb00259.x. [DOI] [PubMed] [Google Scholar]
  4. Flamm B. L., Dunnett C., Fischermann E., Quilligan E. J. Vaginal delivery following cesarean section: use of oxytocin augmentation and epidural anesthesia with internal tocodynamic and internal fetal monitoring. Am J Obstet Gynecol. 1984 Mar 15;148(6):759–763. doi: 10.1016/0002-9378(84)90562-3. [DOI] [PubMed] [Google Scholar]
  5. Gibbs C. E. Planned vaginal delivery following cesarean section. Clin Obstet Gynecol. 1980 Jun;23(2):507–515. doi: 10.1097/00003081-198006000-00019. [DOI] [PubMed] [Google Scholar]
  6. Horenstein J. M., Eglinton G. S., Tahilramaney M. P., Boucher M., Phelan J. P. Oxytocin use during a trial of labor in patients with previous cesarean section. J Reprod Med. 1984 Jan;29(1):26–30. [PubMed] [Google Scholar]
  7. Jarrell M. A., Ashmead G. G., Mann L. I. Vaginal delivery after cesarean section: a five-year study. Obstet Gynecol. 1985 May;65(5):628–632. [PubMed] [Google Scholar]
  8. LAWLER P. E., Sr, BULFIN M. J., LAWLER F. C., LAWLER P. E., Jr A review of vaginal delivery following cesarean section, from private practice. Am J Obstet Gynecol. 1956 Aug;72(2):252–259. doi: 10.1016/0002-9378(56)90109-0. [DOI] [PubMed] [Google Scholar]
  9. Lavin J. P., Stephens R. J., Miodovnik M., Barden T. P. Vaginal delivery in patients with a prior cesarean section. Obstet Gynecol. 1982 Feb;59(2):135–148. [PubMed] [Google Scholar]
  10. McGarry J. A. The management of patients previously delivered by caesarean section. J Obstet Gynaecol Br Commonw. 1969 Feb;76(2):137–143. doi: 10.1111/j.1471-0528.1969.tb05808.x. [DOI] [PubMed] [Google Scholar]
  11. Meehan F. P., Moolgaoker A. S., Stallworthy J. Vaginal delivery under caudal analgesia after caesarean section and other major uterine surgery. Br Med J. 1972 Jun 24;2(5816):740–742. doi: 10.1136/bmj.2.5816.740. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Meier P. R., Porreco R. P. Trial of labor following cesarean section: a two-year experience. Am J Obstet Gynecol. 1982 Nov 15;144(6):671–678. doi: 10.1016/0002-9378(82)90436-7. [DOI] [PubMed] [Google Scholar]
  13. Morewood G. A., O'Sullivan M. J., McConney J. Vaginal delivery after cesarean section. Obstet Gynecol. 1973 Oct;42(4):589–595. doi: 10.1097/00006250-197310000-00018. [DOI] [PubMed] [Google Scholar]
  14. Nielsen T. F., Hökegård K. H., Moldin P. G. X-ray pelvimetry and trial of labor after previous cesarean section. A prospective study. Acta Obstet Gynecol Scand. 1985;64(6):485–490. doi: 10.3109/00016348509156726. [DOI] [PubMed] [Google Scholar]
  15. Pauerstein C. J., Karp L., Muher S. Trial of labor after low segment cesarean section. South Med J. 1969 Aug;62(8):925–928. doi: 10.1097/00007611-196908000-00006. [DOI] [PubMed] [Google Scholar]
  16. Saldana L. R., Schulman H., Reuss L. Management of pregnancy after cesarean section. Am J Obstet Gynecol. 1979 Nov 1;135(5):555–561. doi: 10.1016/s0002-9378(16)32976-3. [DOI] [PubMed] [Google Scholar]
  17. WILSON A. L. Labor and delivery after cesarean section. Am J Obstet Gynecol. 1951 Dec;62(6):1225–1233. doi: 10.1016/0002-9378(51)90048-8. [DOI] [PubMed] [Google Scholar]
  18. ZONDEK B., GOLDBERG S. Placental function and foetal death. I. Urinary gonadotrophin titration test in early pregnancy. II. Urinary oestriol excretion test in advanced pregnancy. J Obstet Gynaecol Br Emp. 1957 Feb;64(1):1–13. doi: 10.1111/j.1471-0528.1957.tb02593.x. [DOI] [PubMed] [Google Scholar]

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