• Wilbert A Spaans, Laura M E van der Vliet, Elisabeth A M Röell-Schorer, Otto P Bleker, and Jos van Roosmalen.
• Department of Obstetrics and Gynaecology, Gelre Ziekenhuis, P.O. Box 9014, 7300 DS, Apeldoorn, The Netherlands. w.spaans@gelre.nl
• Eur. J. Obstet. Gynecol. Reprod. Biol. 2003 Sep 10; 110 (1): 16-9.

ObjectiveTo investigate the safety of a trial of labour (TOL) after two or three previous caesarean sections.Study DesignRetrospective analysis of medical records of women with a history of more than one previous caesarean section who gave birth during a 10-year period (1988-1997) in two large university hospitals in The Netherlands.ResultsWomen numbering 30,132 gave birth with a hospital caesarean birth rate of 14.8%. There were 246 women with a history of more than one previous caesarean section: 187 (76%) delivered by elective repeat caesarean section (ERCS); 59 (24%) had a trial of labour, of whom 49 (83%) had a vaginal birth. Three uterine ruptures occurred after previous lower segment caesarean sections without maternal or perinatal mortality related to the uterine rupture; only one rupture was during a trial of labour. In the study group there was no maternal mortality. Maternal morbidity did not differ between women with an elective repeat caesarean or a failed trial of labour. Perinatal mortality was not related to the mode of delivery.ConclusionElective repeat caesarean section is not the only answer to a woman with two or three previous caesarean sections. A trial of labour can be a safe option for a selected group of women.

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