Introduction
Rates of cesarean deliveries (CD) have substantially increased in recent decades to approximately 21% of births worldwide1with the most common indication for CD being a previous uterine scar2. Repeat CD is associated with significant morbidities including: the need for blood transfusion, bowel and bladder injury and placenta previa with its related complications3,4. In 1980, the National Institute of Child Health and Human Development Conference on Childbirth concluded that vaginal delivery (VD) after a CD is a relevant alternative. Successful vaginal birth after CD (VBAC) compared to elective repeat CD is associated with fewer complications. However, a failed trail of labor after CD (TOLAC) is associated with serious complications. Therefore, efforts are made in order to identify the best candidates for TOLAC5.The American College of Obstetrics and Gynecology (ACOG) committee opinion from 1994 on the issue of TOLAC stated that TOLAC after two or more previous CDs should not be discouraged.6Thereafter, institutions consented and allowed TOLAC following two previous CD7–10. Subsequently, the ACOG guidelines from 201911 maintains that it is reasonable to consider parturients with two previous low segment transverse (LSTCS) CD as appropriate candidates for TOLAC following a thorough individual consultation assessing their previous and current obstetrical history and their probability of achieving a successful VBAC.
Initiated in 2000, our medical center follows a strict protocol regarding TOLAC in parturients who previously had 2 CD. There is a paucity of data regarding maternal and neonatal risks associated with TOLAC in this specific population. The purpose of this study was to investigate the outcomes of TOLAC following two CD versus a third repeat elective CD and to explore factors associated with successful TOLAC.