Vaginal Birth After Cesarean

Systematic Review


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


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.