Vaginal delivery after cesarean section. Experience in private practice
E. Gellman, M. S. Goldstein, S. Kaplan and W. J. Shapiro
To test whether vaginal delivery after cesarean section (VDAC) is a safe
alternative to repeated section, a retrospective chart review of 2,350
deliveries during a ten-year period in a private practice group committed
to VDAC was studied. Eighty-five parturients met six predetermined safety
criteria and were permitted a trial of labor. These criteria were (1) prior
low-segment transverse uterine incision; (2) vertex presentation; (3)
carefully monitored labor with obstetrician present; (4) availability of
emergency facilities; (5) no administration of oxytocin; and (6) patients'
consent and desire to pursue VDAC. Seventy-six labors (89%) managed
expectantly were successful in VDAC. No maternal or fetal morbidity was
detected. No uterine ruptures were detected on postpartum examination or at
the time of cesarean section. These results support the 1980 report of the
National Institute of Child Health and Human Development recommending that
labor and VDAC are of low risk to mother and fetus in properly selected
cases.
