Choosing Wisely:

Don’t routinely exclude women with two prior low transverse cesarean deliveries from having the choice to undertake a trial of labor after cesarean.

Rationale and Comments: Although in some studies, women with two prior cesarean deliveries who attempt a trial of labor after cesarean have a higher rate of complications than women with one prior cesarean delivery, the absolute risk of any major complication remains low and the chance of achieving a vaginal birth are similar to those who have one prior cesarean. Given the risk of maternal morbidity and placenta accreta spectrum associated with multiple cesarean deliveries, a trial of labor should remain an option for women with two prior low transverse cesarean deliveries.
Sponsoring Organizations:
  • Society for Maternal-Fetal Medicine
  • Sources:
  • Expert consensus
  • Disciplines:
  • Obstetrical
  • References: • Landon MB, Spong CY, et al.; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Risk of uterine rupture with a trial of labor in women with multiple and single prior cesarean delivery. Obstet Gynecol. 2006;108(1):12-20.
    • Macones GA, Cahill A, et al. Obstetric outcomes in women with two prior cesarean deliveries: is vaginal birth after cesarean delivery a viable option? Am J Obstet Gynecol. 2005;192(4):1223-8; discussion 1228-1229.

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