ABSTRACT
The overall rate of cesarean section increased or decreased with the fall or rise in the rate of vaginal birth after previous cesarean section (VBAC), respectively. The risk of uterine rupture in patients undergoing trial of labor after cesarean section (TLCS) ranges from 0.4% to 0.5% with spontaneous labor and 0.8% to 1.1% with oxytocin induction of labor. Epidural anesthesia is not associated with an increased risk of uterine rupture in patients undergoing TLCS. Trial of labor in patients with fetal macrosomia is associated with an increased risk of uterine rupture and perinatal or maternal morbidity or mortality. Patients who undergo a trial of labor after a previous low uterine vertical cesarean section have VBAC success rates ranging from 83% to 85%, risks of uterine rupture ranging from 1.1% to 1.3%, and no maternal deaths. Fetal macrosomia and epidural anesthesia do not appear to increase the risk of uterine rupture.
