Mandatory trial of labor after cesarean delivery: an alternative viewpoint.

Twelve women experienced major rupture of the uterus during a trial of labor after previous cesarean (low transverse cervical incision in 11, low vertical in one). Two women required hysterectomy and a third had serious postoperative complications. There were three perinatal deaths, and two infants suffered significant long-term neurologic impairment. Although vaginal birth after cesarean delivery is considered safe in most instances, these cases serve as a reminder that catastrophic events can occur. Potential complications have important implications for clinicians when counseling patients about the route of delivery and for the management of any trial of labor after cesarean delivery.