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Am J Obstet Gynecol. 2004 Oct;191(4):1263-9.

Comparison of maternal mortality and morbidity between trial of labor and elective cesarean section among women with previous cesarean delivery.

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  • 1Division of Health Surveillance and Epidemiology, Centre for Healthy Human Development, Health Canada, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada. swwen@ohri.ca

Abstract

OBJECTIVE:

This study was undertaken to assess the safety of trial of labor after previous cesarean delivery.

STUDY DESIGN:

Retrospective cohort study of 308,755 Canadian women with previous cesarean delivery between 1988 and 2000. Occurrences of in-hospital maternal death, uterine rupture, and other severe maternal morbidity were compared between women with a trial of labor and those with an elective cesarean section.

RESULTS:

Rates of uterine rupture (0.65%), transfusion (0.19%), and hysterectomy (0.10%) were significantly higher in the trial-of-labor group. Maternal in-hospital death rate, however, was lower in the trial-of-labor group (1.6 per 100,000) than in the elective cesarean section group (5.6 per 100,000). The association between trial of labor and uterine rupture was stronger in low volume (<500) than in high volume (> or =500 births per year) obstetric units.

CONCLUSION:

Trial of labor is associated with increased risk of uterine rupture, but elective cesarean section may increase the risk of maternal death.

PMID:
15507951
[PubMed - indexed for MEDLINE]
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