Background: Repeat caesarean section and planned vaginal birth after caesarean section are both associated with benefits and harms.

Methods: Prospective data was recorded on management practices, associated complications, morbidity and mortality on 15664 consecutive cases of previous cesarean section reporting at 30 medical colleges/teaching hospitals for delivery.

Results: A total of 4035 (25.8%) women out of the 15664 women with a previous cesarean section underwent a trial of labor (TOL). Of these, 2513 (62.0%) had a successful trial of labor (S-TOL) while the rest required an emergency repeat cesarean section. The overall maternal morbidity was 2.3%and 34.0% in women with S-TOL and failed trial of labor (F-TOL) respectively. Blood loss  more than 1000ml was seen in 20.6% of cases with F-TOL where as for S-TOL it was 0.3%, blood transfusion was 7.0% in F-TOL where as it was 0.8% in S-TOL, dehiscence of scar in F-TOL was 5.4% as compared to 0.2% in S-TOL, post-operative complication/delivery were seen in 6.8% cases in F-TOL where as in S-TOL it was 0.4%, uterine rupture was 0.7% in F-TOL as compared to 0.1% in S-TOL and was statistically significant. Maternal death was seen in 4 (0.3%) cases of F-TOL as compared to 6 (0.2%) cases in S-TOL (p=0.45) and the difference was not significant. There were 27 (1.8%) child deaths who born after F-TOL as compared to 65 (2.6%) born after S-TOL which was highly significant (P=0.00).

Conclusions: Women who experience failed trial of labor have higher risk of morbidity as compared to those with a successful trial of labor. More accurate prediction for safe, successful vaginal birth after cesarean delivery is needed.

Keywords: Cesarean section, trail of labor, maternal morbidity, mortality.

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B.S. Dhillon

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