Elective repeat cesarean delivery compared with spontaneous trial of labor after a prior cesarean delivery: a propensity score analysis

Am J Obstet Gynecol. 2012 Apr;206(4):311.e1-9. doi: 10.1016/j.ajog.2012.02.002.


Objective: The purpose of this study was to determine outcomes, after the use of propensity score techniques, to create balanced groups according to whether a woman undergoes elective repeat cesarean delivery (ERCD) or trial of labor (TOL).

Study design: Women who were eligible for a TOL with 1 previous low transverse incision were categorized according to whether they underwent an ERCD or TOL. A propensity score technique was used to develop ERCD and TOL groups with comparable baseline characteristics. Outcomes were assessed with conditional logistic regression.

Results: The rates of endometritis, operative injury, respiratory distress syndrome, and newborn infant infection were lower and the rates of hysterectomy and wound complication were higher in the ERCD group.

Conclusion: Propensity score techniques can be used to generate comparable ERCD and TOL groups. Some types of maternal morbidity (such as hysterectomy) are higher; other types (such as operative injury) are lower in the ERCD group. Although the absolute risk is low, neonatal morbidity appears to be lower in the ERCD group.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Cesarean Section, Repeat / adverse effects
  • Cesarean Section, Repeat / statistics & numerical data*
  • Elective Surgical Procedures / statistics & numerical data*
  • Endometriosis / epidemiology
  • Female
  • Humans
  • Infant, Newborn
  • Infant, Newborn, Diseases / epidemiology
  • Pregnancy
  • Pregnancy Complications, Infectious / epidemiology
  • Pregnancy Outcome / epidemiology
  • Propensity Score*
  • Respiratory Distress Syndrome, Newborn / epidemiology
  • Trial of Labor*
  • Uterine Rupture / epidemiology
  • Vaginal Birth after Cesarean / statistics & numerical data

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