[Particular maternal or fetal clinical conditions influencing the choice of the mode of delivery in case of previous cesarean]

Abstract

Objective: To determine how particular maternal (age>35 years, multiparity, diabetes and obesity) or fetal (breech presentation, twin pregnancy, macrosomia, prolonged pregnancy, preterm delivery) clinical conditions, potentially associated with increased risk of failed trial of labor, uterine rupture, and perinatal asphyxia, should indicate a planned cesarean delivery or could still allow a planned vaginal birth after cesarean.

Methods: The PubMed database, the Cochrane Library and the recommendations from the French and foreign obstetrical societies or colleges have been consulted.

Results: For grand multiparous patients or preterm birth, a planned vaginal delivery should be encouraged (gradeC). For patients with a fetus estimated more than 4500 g, especially in the absence of previous vaginal delivery, or in case of supermorbid obesity (BMI>50), a planned cesarean delivery is recommended (gradeC). For all other clinical conditions (maternal age>35 years, diabetes, morbid obesity, breech presentation, twin pregnancy, prolonged pregnancy), although planned vaginal delivery is possible, a planned mode of delivery cannot be recommended because the levels of evidences are too low in case of previous cesarean (gradeC).

Conclusions: Only few particular clinical conditions justify, by themselves, a planned cesarean delivery (EL3).