Risk of Perinatal Death Associated With Labor After Previous Cesarean Delivery in Uncomplicated Term Pregnancies

Abstract

Increasing rates of cesarean delivery are a major cause for concern in almost all developed countries.¹ A number of strategies have been proposed that aim to reduce the overall proportion of cesarean deliveries, including trial of labor after previous cesarean deliveries.² Observational studies^3,4 suggest that trial of labor is associated with a significantly increased risk of uterine rupture. A meta-analysis reported an increased risk of perinatal death associated with trial of labor⁵ but included premature births between 28 and 36 weeks' gestation and breech deliveries.⁶ There is no large-scale study of the relative and absolute risks of perinatal death among women previously delivered by cesarean method but with an uncomplicated pregnancy at term. In the present study, we sought to address this by linking national registers of pregnancy discharge data and perinatal deaths.