Vaginal Birth After Cesarean

Systematic Review

Question

What are the risks of planned vaginal birth vs. planned cesarean section after previous cesarean section?

Answer

The risk of uterine rupture among women with a previous cesarean section increases by 2-9/1,000 for those planning vaginal versus cesarean delivery. Risk of uterine rupture increases when labour is induced, particularly with prostaglandins, to a maximum reported rate of 15/1,000. Maternal mortality is 0.2-0.4/1,000 less frequent in planned vaginal versus cesarean birth. Comparisons of perinatal mortality are inconsistent across studies and vary with differences of 0-3/1,000 in either direction. There is decreased maternal and newborn morbidity associated with planned vaginal birth. Overall this review suggests that healthy women at term with a singleton fetus should be encouraged to plan vaginal birth after a discussion of risk vs. benefit. Induction of labour should also be offered after a discussion of risk vs. benefit.