Why Women With Previous Caesarean and Eligible for a Trial of Labour Have an Elective Repeat Caesarean Delivery? A National Study in France

Abstract

(BJOG. 2016;123(10):1664–1673) Cesarean section (CS) rates have increased worldwide resulting in a concurrent increase in the percentage of pregnant women with a history of previous CS. In the United States in 2013, 15% of all births occurred in women with a previous CS. Likewise in France in 2010, women with a previous CS accounted for 11% of all deliveries. This is cause for concern because these women are at greater risk for certain high-risk conditions such as placenta accreta and uterine rupture along with associated increases in maternal and neonatal morbidity and mortality. For these women, it is important to discuss plans regarding the mode of delivery—elective repeat cesarean delivery (ERCD) or a trial of labor after cesarean (TOLAC). For the majority of women, national guidelines recommend TOLAC. However, in the United States and Europe, the ERCD rates are much higher than would be expected if guidelines regarding recommended delivery plan were followed. The objective of this study performed in France was to identify the characteristics of patients and maternity units when ERCD was performed in women who were eligible for TOLAC.