More than one previous cesarean delivery: a 5-year experience with 435 patients.

OBJECTIVE: To evaluate the obstetric outcome of patients who have had more than one previous cesarean delivery, and to compare it with that of patients with one previous cesarean.

METHODS: Medical records of 435 women with more than one previous cesarean and 1206 with one previous cesarean, and who delivered at our institution in the period 1987-1991, were reviewed retrospectively. All adverse outcomes related to uterine wound separation identified in medical records were reviewed individually. Statistical analysis of outcome used chi 2 test, Fisher exact test, and odds ratios with 95% confidence intervals.

RESULTS: Uterine wound separation occurred in nine of 435 patients with more than one previous cesarean compared with 16 of 1206 with a single previous cesarean (2.1 versus 1.3%, not significant). Of those undergoing a trial of labor, separations occurred in six of 302 and 12 of 1110 patients with more than one and a single previous operation, respectively (2.0 versus 1.1%, not significant). Vaginal birth after cesarean was successful less often in women with more than one previous cesarean than in those with one previous operation (64 versus 77%, P < .05). Important adverse outcomes were infrequent and not related to the number of previous cesareans.

CONCLUSION: Our findings support allowing a trial of labor for patients with more than one previous cesarean delivery under conditions that permit prompt recognition and treatment of emergencies.