Objective To determine the outcome of trial of labour after two caesarean sections.
Design Prospective observational study.
Setting Maternity and Children's Hospital, Riyadh, Saudi Arabia.
Subjects Women with two previous caesarean sections considered suitable for a trial of vaginal delivery.
Main outcome measures The rates of vaginal delivery, scar dehiscence, uterine rupture and associated complications among 115 women with two previous sections who underwent trial of labour were compared with 1006 women with two previous sections who did not have a trial of labour.
Results Trial of vaginal delivery was requested by 230 out of 1136 women (20%) who had two previous caesarean sections. Of the 115 women accepted for the trial, 103 (89%) were delivered vaginally. Labour started spontaneously in 78 (68%) of the 115 women and was induced with prostaglandin (PGE2) in the remaining 37. Augmentation of labour with oxytocin was required in 32 (28%) of the trial labour group. There were no scar dehiscences among the women delivered vaginally. There was one scar dehiscence and one woman required hysterectomy after failed trial of labour, a frequency comparable to the occurrence of these complications in women who did not have a trial of labour.
Conclusion A trial of labour in selected patients with two previous caesarean sections appears a reasonable option.