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

Am J Obstet Gynecol. 2004 Oct;191(4):1263-9. doi: 10.1016/j.ajog.2004.03.022.


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.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Blood Transfusion / statistics & numerical data
  • Canada
  • Cesarean Section* / mortality
  • Elective Surgical Procedures
  • Female
  • Hospitals, Community
  • Humans
  • Hysterectomy / statistics & numerical data
  • Maternal Mortality*
  • Morbidity
  • Pregnancy
  • Trial of Labor*
  • Uterine Rupture / epidemiology