Despite the recent trend away from a TOL after cesarean delivery, this option remains relatively safe, and uterine rupture is fairly rare. Although maternal morbidity may be increased after a failed TOL, women who choose TOL have a more favorable outcome profile on average than those choosing ERC.
Even though ERC offers more positive fetal and infant safety profiles, the magnitude of this benefit is quite small. In our review and meta-analysis, we calculated that between 374 and 809 women would need to undergo ERC to prevent 1 uterine rupture, and between 693 and 3,332 women would need to undergo ERC to prevent 1 perinatal death attributable to a TOL.9
Overall, the literature suggests that a risk-benefit analysis is likely to favor TOL when the probability of success is high—as it usually is—and likely to favor ERC when that probability declines, as with induction of labor in the setting of an unfavorable cervix. Each woman’s appraisal of the risks and benefits will depend on how she values each possible outcome of these delivery methods. All told, however, a TOL remains a valid option for most women with a prior cesarean delivery.
The author reports no financial relationship with any companies whose products are mentioned in this article.
