Vaginal birth after cesarean

Cesarean section rate has risen dramatically, particularly in the U.S., over the past 20 years, with results on maternal and perinatal mortality or morbidity and increase of delivery cost, To curb this inflation, trial of labor after cesarean section is proposed. Trial of labor often involves use of oxytocics, Regional analgesia is indicated for this high risk delivery, There are few absolute contra-indications to trial of labor and each case has to be analysed separately, Induction of labor leads to several advantages, The repeat cesarean section rate decreases significantly; this high risk delivery can take place during daytime with complete obstetrical, anaesthetic and pediatric staff, The use of medication such as vaginal prostaglandins or mifepristone can also help lower this rate, X-ray pelvimetry must no longer be the major criterion for choosing the mode of delivery, Normality of labour must be judged according to previous vaginal delivery or not. Revision of uterine scar remains important for the diagnosis of dehiscence or rupture. This exploration should only be done if symptoms appear.