Evidence map›Paper›PMID 39207474›Full record

ArticleArchives of gynecology and obstetrics2025

Trial of labor after caesarean section in low risk pregnancies: is it risky?

Sven Kehl, Hanna Düster, Christel Weiss, Simon Bader, Michael Schneider, Matthias W Beckmann, Ulf Dammer, Jutta Pretscher

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In one paragraph

Article in Archives of gynecology and obstetrics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Sven KehlDepartment of Obstetrics and Gynecology, Erlangen University Hospital, Universitätsstr. 21-23, 91054, Erlangen, Germany. sven.kehl@gmail.com.ORCID 0000-0002-2220-371X
Hanna DüsterDepartment of Medical Statistics and Biomathematics, University Medical Center Mannheim, Heidelberg University, Mannheim, Heidelberg, Germany.
Christel WeissDepartment of Medical Statistics and Biomathematics, University Medical Center Mannheim, Heidelberg University, Mannheim, Heidelberg, Germany.
Simon BaderDepartment of Obstetrics and Gynecology, Erlangen University Hospital, Universitätsstr. 21-23, 91054, Erlangen, Germany.
Michael SchneiderDepartment of Obstetrics and Gynecology, Erlangen University Hospital, Universitätsstr. 21-23, 91054, Erlangen, Germany.
Matthias W BeckmannDepartment of Obstetrics and Gynecology, Erlangen University Hospital, Universitätsstr. 21-23, 91054, Erlangen, Germany.
Ulf DammerDepartment of Obstetrics and Gynaecology, St. Theresien Hospital, Nuremberg, Germany.
Jutta PretscherDepartment of Obstetrics and Gynecology, Erlangen University Hospital, Universitätsstr. 21-23, 91054, Erlangen, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeTo evaluate the influence of a previous caesarean section on adverse composite maternal and perinatal outcome in women who attempted a trial of labor.

methodsThis historical cohort study analyzed maternal and perinatal outcome in women with otherwise low risk pregnancies at term who underwent a trial of labor after a caesarean section (TOLAC). The primary outcome measure was the adverse composite outcome. Secondary outcome measures were amongst others the caesarean section rate and the mode of vaginal delivery.

resultsThe adverse composite outcome was more frequently in the previous caesarean section group compared to women with no previous caesarean Sect. (22.3% vs. 15.6%, p < 0.0001). The percentage of caesarean Sect. (15.4% vs. 8.2%, p < 0,0001), uterine rupture (1.0% vs. 0.02%, p < 0.0001), placental abruption (1.1% vs. 0.3%, p = 0.0014), vaginal operative delivery (16.0% vs. 8.6%, p < 0.0001), pH < 7.10 (3.7% vs. 2.5%, p = 0.0151), base excess < -12 (3.2% vs. 2.2%, p = 0.0297), abnormal cardiotocography (22.5% vs. 13.9%, p < 0,0001) and fetal blood analysis (6.2% vs. 2.6%, p < 0.0001) was significantly higher in women with a previous caesarean section. Taking the parity into account, these differences could only been seen in women without a previous vaginal delivery. In parous women with a previous vaginal delivery and a caesarean section in history, the adverse composite did not differ between the groups. Only the rate of pH < 7.1 was higher in women after a caesarean Sect. (4.5% vs. 1.8%, p = 0.0436).

conclusionTrial of labor after caesarean in otherwise low risk pregnancies is associated with a higher rate of complications especially if there is no history of vaginal delivery.

Indexed as

Cesarean SectionTrial of LaborVaginal Birth after CesareanAdultCohort StudiesFemaleHumansPregnancyPregnancy OutcomeRetrospective StudiesRisk FactorsUterine RuptureYoung AdultCaesarean section rateComposite adverse outcomePrior caesarean sectionTOLACUterine ruptureVBAC

Identifiers

PMID39207474
PMCPMC11985613

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.