The management of labor in women with more than one uterine scar: is a repeat cesarean section really the only "safe" option?

A prospective trial to investigate feasibility of vaginal delivery after more than one cesarean section, and the safety of vaginal delivery for mother and neonate. Twenty-six pregnant women with a history of two or more cesarean sections were admitted to the delivery room and accepted trial of labor under internal fetal and uterine monitoring. Epidural anesthesia and oxytocin were applied when needed. A similar group of patients (controls) preferred repeated cesarean section. Nineteen women (73%) were successfully delivered by the vaginal route. There were no cases of uterine rupture or perinatal loss. The maternal complication rate was lower than that of the control group. Trial of labor in selected cases of two or more low-segment cesarean sections may be considered safe for mother and fetus.