Delivery outcomes at term after one previous cesarean section

OBJECTIVE: To determine the maternal and perinatal outcomes at term in women with one previous cesarean delivery and with no history of vaginal birth.

METHODS: This is a case-control study conducted at King Abdul-Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia, between January 1, 1999 and December 31, 2002. One hundred sixty-two women with one previous cesarean delivery and with no previous vaginal birth were compared with 324 control women.

RESULTS: The cesarean section rate was higher in the study group 40 (24.7%) versus 23 (7.1%) in the control group and was statistically significant (p<0.001). Seventeen (10.5%) were induced with prostaglandin E2, and 33 (20.4%) required labor augmentation with oxytocin in the study, versus 22 (6.8%) and 21 (6.5%) in the control group. The duration of labor was longer in the study women compared to the control group (7.6 ± 3.0 hours versus 6.0 ± 2.3 hours), and this was statistically significant (p<0.001). There was one uterine dehiscence, and 2 uterine ruptures in the study women, and none in the control group. Eight (1.65%) women had postpartum hemorrhage, 3 (0.62%) needed blood transfusion, and 7 (1.44%) developed postpartum pyrexia.

CONCLUSION: Women with no a prior history of vaginal delivery are considered less favorable, the vaginal birth after cesarean section success rate may be even lower if the indication for previous primary cesarean delivery was failure to progress, and may be associated with increased risk of uterine rupture. Further study is required to confirm our findings.