ArticlePloS one2025
Is it safe for women with a history of two cesarean deliveries to undergo a vaginal delivery attempt in comparison to patient with a history of one cesarean delivery?
Article in PloS one, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
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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.
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Who cites it
2 citing papers in PubMed.
- Association between adverse obstetric history and perinatal outcomes in singleton and twin pregnancies: a retrospective study.Frontiers in medicine · 2026Article
- Factors influencing failed vaginal trial of labor and subsequent cesarean section in elderly multiparous women, and maternal and neonatal outcomes.Frontiers in global women's health · 2026Article
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Authors and funding
9 authors.
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No grant is acknowledged in the PubMed record.
Abstract
introductionWorldwide, numbers of repeat cesarean sections continue to rise. Although there is a multitude of evidence about the safety of a vaginal delivery attempt after one cesarean section, data is scarce regarding the risks of one compared to two prior procedures. This study aims to determine whether vaginal childbirth is less safe and successful for both mother and child in patients with a history of two cesarean sections compared to those with only one. MATERIALS AND
methodsThis retrospective cohort study included all patients with a history of one or two prior cesarean deliveries who gave birth at term at Goethe University Frankfurt between 2014 and 2021. Maternal and neonatal morbidity, as well as rates of success for vaginal birth and uterine rupture, were compared between the groups.
resultsOf the 1967 women studied, 1697 gave birth after one previous cesarean section, while 270 had a history of two prior cesarean sections. There was no significant increase in maternal or fetal morbidity in women with two previous cesarean sections compared to one. However, the success rate of a vaginal delivery was lower in the group with two prior cesareans (27/79, 34.2%) than in the group with one (696/989, 70.3%). The rate of complete uterine rupture was higher in patients with two cesareans who underwent cesarean section after onset of labor (CSAOL-2: 3/89, 3.4%) compared to none in the CSAOL-1 group (0/492, 0.0%; p = 0.004). Maternal and fetal morbidity remained comparable across groups, with NICU admission rates of 11.2% (CSAOL-1) vs. 5.6% (CSAOL-2), and maternal transfusion rates of 0.86% (VBAC-1) vs. 6.45% (VBAC-2).
conclusionIn the context of patient autonomy regarding the timing of delivery, offering the patient the choice of different delivery modes after two previous cesareans appears to be safe with respect to maternal and fetal risks. An individualized consultation and thorough counseling are essential, but the opportunity for different delivery options should be respected and supported.
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