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Ann Saudi Med. 2004 Jul-Aug;24(4):276-9.

Vaginal birth following two cesarean deliveries--are the risks exaggerated?

Author information

  • 1Department of Obstetrics & Gynecology, Al Hasa Health Center (Saudi Aramco Medical Services Organization), Saudi Aramco, Al Hasa, Saudi Arabia. gargvk@aramco.com



Prior to 1996, most women who had undergone two previous cesarean deliveries were offered only cesarean delivery at Al-Hasa Health Centre. A policy of trial of labor was instituted in 1996. We compared the outcome of trial of labor versus cesarean delivery in women with a history of two previous cesarean deliveries who delivered between 1997 and 2002.


All patients with a history of two previous lower segment cesarean deliveries were included in the study. Those considered suitable were permitted a trial of labor that was neither induced nor augmented at any stage.


Of the 205 patients in the study, 66 delivered vaginally (32.2%), 68 had an emergency cesarean delivery (33.2%), and 71 an elective cesarean delivery (34.6%). No scar dehiscence was observed, nor was hysterectomy performed in either group. The rate of complications was lower in the vaginal delivery group (4.5%) than in the cesarean delivery group (19.4%).


Trial of labor in women with a history of two cesarean deliveries is a reasonable consideration, and when carried out without the use of oxytocics or prostaglandins, is associated with reduced maternal morbidity with no difference in perinatal morbidity.

[PubMed - indexed for MEDLINE]
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