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Trial of labour after caesarean 

Trial of labour after caesarean
Trial of labour after caesarean

Emily S. Miller

and William A. Grobman

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date: 27 October 2020

Rates of caesarean section have increased globally, in part due to a steady decline in the number of women undergoing a trial of labour after caesarean (TOLAC). This chapter reviews the various issues around vaginal birth after a previous caesarean delivery. Understanding the balance of maternal and neonatal risks in women undergoing a repeat caesarean or a TOLAC is critical to patient counselling regarding route of delivery after one prior caesarean. The impact of this decision on potential future pregnancies should also be taken into account. One of the major risks of TOLAC is uterine rupture. Careful patient selection for TOLAC, with optimization of intrapartum management, including early recognition of signs of rupture, is critical. Overall, morbidity is lowest if a vaginal birth after caesarean (VBAC) is achieved but is highest if an intrapartum caesarean occurs.

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