Outcome of a labor trial for women with a history of two cesarean sections: a retrospective cohort study

Objective. The global rise in cesarean section (CS) rates has led to an increasing number of women with multiple prior CSs. Despite evidence supporting trial of labor after two cesareans (TOLA2C), it remains underused in many settings owing to concerns about complications such as uterine rupture. This study aimed to compare the outcomes of TOLA2C andelective repeat cesarean section (ERCS) and identify factors associated with successful vaginal birth after two CSs (VBA2C). Methods. This retrospective cohort study included 333 women with two or more previous cesarean sections who gave birth between January 2021 and December 2023. Women with multiple pregnancies were excluded. Patients were categorized into the ERCS and TOLA2C groups. Data on maternal characteristics, birth outcomes, and complications were extracted from digital medical records. Results. A total of 333 women fulfilled the study criteria. Among them, 295 (88.6 %) underwent ERCS, whereas 38 (11.4 %) attempted TOLA2C. The success rate of VBA2C was 60.5 % (23/38), whereas 39.5 % (15/38) required an unplanned CS. Uterine rupture was documented in one TOLA2C patient (2.7 %) and 17 ERCS patients (5.8 %). No maternal deaths or embolic events were reported, and only one hysterectomy and one case of intrauterine infection occurred. Generally, there were no significant differences in maternal or neonatal complications between the two groups. Conclusion. There was no difference in maternal or neonatal morbidity among patients in our study population with two previous CSs who opted for TOLA2C versus ERCS. In conclusion, TOLA2C should be discussed in appropriate cases as an alternative mode of delivery.