Elective repeat caesarean section versus vaginal birth for 2 423 women with a previous caesarean birth

Objective To investigate the delivery mode, clinical characteristics and outcome of 2 423 women with a previous caesarean birth in Affiliated Hospital of Yan'an University in recent 5 years. Methods From January 2013 to December 2017, 2 423 pregnant women with previous cesarean section admitted to our hospital. According to the mode of delivery, they were divided into elective repeat cesarean delivery (ERCD) group (n=2 184) and trial of labor after cesarean (TOLAC) group (n=239). The complications of pregnancy, postpartum complications and neonatal outcomes were compared between two groups. Results Compared with TOLAC group, ERCD group had less gestational age(38.2±2.6) weeks vs (39.4±1.3) weeks, less parity1(1-1)vs 1(1-2), smaller lower uterine segment thickness(30.5±3.6) mm vs (33.7±2.9) mm and shorter interdelivery interval(3.8±2.7) years vs(4.6±3.1) years (all P< 0.05). The incidence of preeclampsia in ERCD group was higher than that in TOLAC group (6.2% vs 0.8%), while the incidence of uterine rupture was lower (0 case vs 2 cases) (P< 0.05, respectively). The 5'Apgar score and birth weight of neonates in ERCD group were all less than those in TOLAC groupApgar, (9.6±0.7) vs (9.8±0.4); birth weight (3 168.5±418.2) g vs (3 250.3±441.3) g (P< 0.05, respectively). Conclusion For pregnant women with a previous caesarean birth, the implementation of TOLAC is relatively safe according to the guidelines, and the mode of delivery should be individualized.