Trial of labor vs. elective repeat cesarean section. AAFP Task Force on Clinical Policies for Patient Care.

A trial of labor after a previous low transverse cesarean section in the absence of ongoing contraindications is safe for most women. A comprehensive review and meta-analysis of the literature was conducted to determine outcomes, costs and women's preferences by method of delivery. About seven of 10 women who undergo a trial of labor after previous low transverse cesarean section can expect to deliver vaginally. The following differences in absolute risks were identified: a trial of labor was associated with a slightly increased risk of uterine rupture (0.24 percent) and a decreased risk of infection and fever (5.2 percent) and postpartum bleeding (0.59 percent) as compared with an elective repeat cesarean section. The difference in risk for newborns with an Apgar score of less than 7 at five minutes was 0.85 percent for infants delivered vaginally after a trial of labor versus infants delivered by elective repeat cesarean section. Financial cost (as measured by hospital charges) of cesarean delivery was 1.66 to 2.4 times greater than the cost of vaginal birth. This difference was due almost entirely to the longer length of hospital stay for women who had a cesarean delivery. When given the opportunity, about two-thirds of eligible women choose a trial of labor over elective repeat cesarean section. The reasons underlying women's preferences for a trial of labor or elective repeat cesarean section were diverse and changed during pregnancy. As a consequence, women's preferences for the method of delivery must be explored and respected throughout pregnancy and during the delivery process.(ABSTRACT TRUNCATED AT 250 WORDS)