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Nov. 24, 1999 (New York) -- Women who have had a prior cesarean delivery have a good chance of successful labor and delivery free of complications, regardless of which of two types of incision were used, according to a report in the November issue of the journal Obstetrics & Gynecology.
Low transverse incision is the most common type of incision used in cesarean delivery, and low vertical incision is the next-most common. The risk of uterine rupture and other complications has been thought to be higher in women with a prior cesarean incision; however, many physicians are comfortable letting such women attempt labor after a low transverse incision but not after a low vertical incision.
"Prior to our study there wasn't much information to help make the decision [about whether to do a trial of labor after a low vertical incision]," lead researcher Thomas D. Shipp, MD, tells WebMD. "I think it will be beneficial for women [to know] that these incisions shouldn't be associated with a higher rate of uterine rupture." Shipp is with the department of obstetrics and gynecology at Massachusetts General Hospital in Boston.
The study involved 3,280 attempts of labor in almost 3,000 women who had had at least one prior low transverse uterine incision and 425 attempts of labor in 377 women who had had at least one prior low vertical incision. Birth weight, epidural use, and oxytocin (a medication used to induce labor) use also were similar between the groups.
In the low transverse group, disruption of the cesarean scar was detected in 38 (1.3%) during the labor attempt compared with six (1.6%) in the low vertical group. The symptomatic rupture rate also was similar in the two groups, with a rupture rate of 1% in the low transverse group and 0.8% in the low vertical group, which Shipp and colleagues say is consistent with previous studies.
Women in the low vertical group were more likely to have a spontaneous vaginal delivery than women in the low transverse group. Death rates of the fetus were 1.1% in the low vertical group and 0.4% in the low transverse group.
"The morbidity was fairly similar between the two groups, which really reassured us that women who have had these incisions shouldn't be at any increased risk in subsequent pregnancies," Shipp tells WebMD.
Among women who experienced uterine rupture, there were no differences between the low transverse and low vertical groups in the death rates of the mother or the baby during birth, and none of the deaths were related to the trial of labor.
Women who have had incisions extending higher up are likely to be at greater risk for uterine rupture than the women in this study who had had low vertical incisions. Shipp says it is important that women who want to attempt labor after a vertical incision talk to their physicians about the type of incision they have had and make the decision from there. "A lot of women who have had low vertical incisions aren't offered a trial of labor," he says. "These results should benefit a small segment of this population and help with the decision."