Vaginal delivery after cesarean section.

The incidence of cesarean scar rupture varies from 0.64 to .24 per cent, with some institutions reporting no ruptures. Associated maternal mortality is extremely low, especially in low segment transverse incisions, so as to be almost nonexistent. Maternal mortality from cesarean section is higher than from vaginal delivery. Fetal mortality as a result of low segment scar rupture is at most 12.5 per cent. With modern methods of monitoring this should be reduced to zero. Several authors already report no fetal mortalities. Patients who have had a previous cesarean section should be allowed an attempt to deliver vaginally based on carefully selected criteria. Their labors should be followed closely by a qualified individual and are expected to follow norm-progressive course. The intrauterine cavity should be explored postpartum for defects. The cost of hospital care to the family is considerably reduced, and hospital bed utilization improved by allowing vaginal deliveries of women who have had previous cesarean sections, because of decreased operative risks, postpartum morbidity, and shorter hospital stays. The recovery period for the patient who delivered vaginally will generally be considerably reduced. Each subsequent pregnancy in which vaginal delivery is contemplated must be screened and managed as though it were her first after a section. Physicians should not charge different fees for elective repeat cesarean section versus vaginal delivery of the previous cesarean. Allowing a trial of labor in carefully selected patients is one step toward decreasing the cesarean section rate.