Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Repeat cesarean delivery

Vincenzo Berghella, MD
Section Editor
Charles J Lockwood, MD, MHCM
Deputy Editor
Vanessa A Barss, MD, FACOG


After a primary cesarean delivery, women who become pregnant again must decide between undergoing a repeat cesarean or trial of labor. Issues specific to repeat cesarean delivery will be discussed here. Primary cesarean delivery, issues common to both primary and repeat cesareans, and trial of labor after a previous cesarean delivery (TOLAC) are reviewed separately.

(See "Choosing the route of delivery after cesarean birth".)

(See "Cesarean delivery: Preoperative planning and patient preparation".)

(See "Cesarean delivery: Surgical technique".)

(See "Cesarean delivery: Postoperative issues".)

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Dec 12, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Kamath BD, Todd JK, Glazner JE, et al. Neonatal outcomes after elective cesarean delivery. Obstet Gynecol 2009; 113:1231.
  2. Spong CY, Mercer BM, D'alton M, et al. Timing of indicated late-preterm and early-term birth. Obstet Gynecol 2011; 118:323.
  3. Ganchimeg T, Nagata C, Vogel JP, et al. Optimal Timing of Delivery among Low-Risk Women with Prior Caesarean Section: A Secondary Analysis of the WHO Multicountry Survey on Maternal and Newborn Health. PLoS One 2016; 11:e0149091.
  4. American College of Obstetricians and Gynecologists. ACOG committee opinion no. 561: Nonmedically indicated early-term deliveries. Obstet Gynecol 2013; 121:911. Reaffirmed 2017.
  5. Tita AT, Landon MB, Spong CY, et al. Timing of elective repeat cesarean delivery at term and neonatal outcomes. N Engl J Med 2009; 360:111.
  6. Chiossi G, Lai Y, Landon MB, et al. Timing of delivery and adverse outcomes in term singleton repeat cesarean deliveries. Obstet Gynecol 2013; 121:561.
  7. Tita AT, Lai Y, Landon MB, et al. Timing of elective repeat cesarean delivery at term and maternal perioperative outcomes. Obstet Gynecol 2011; 117:280.
  8. Martin JN Jr, Perry KG Jr, Roberts WE, Meydrech EF. The case for trial of labor in the patient with a prior low-segment vertical cesarean incision. Am J Obstet Gynecol 1997; 177:144.
  9. American College of Obstetricians and Gynecologists. ACOG committee opinion no. 560: Medically indicated late-preterm and early-term deliveries. Obstet Gynecol 2013; 121:908. Reaffirmed 2017.
  10. Stotland NE, Lipschitz LS, Caughey AB. Delivery strategies for women with a previous classic cesarean delivery: a decision analysis. Am J Obstet Gynecol 2002; 187:1203.
  11. Pruett KM, Kirshon B, Cotton DB. Unknown uterine scar and trial of labor. Am J Obstet Gynecol 1988; 159:807.
  12. Osmundson SS, Garabedian MJ, Lyell DJ. Risk factors for classical hysterotomy by gestational age. Obstet Gynecol 2013; 122:845.
  13. Marshall NE, Fu R, Guise JM. Impact of multiple cesarean deliveries on maternal morbidity: A systematic review. Am J Obstet Gynecol 2011; 205:262.e1.
  14. Puttanavijarn L, Phupong V. Comparisons of the morbidity outcomes in repeated cesarean sections using midline and Pfannenstiel incisions. J Obstet Gynaecol Res 2013; 39:1555.
  15. Tulandi T, Agdi M, Zarei A, et al. Adhesion development and morbidity after repeat cesarean delivery. Am J Obstet Gynecol 2009; 201:56.e1.
  16. Soltan MH, Al Nuaim L, Khashoggi T, et al. Sequelae of repeat cesarean sections. Int J Gynaecol Obstet 1996; 52:127.
  17. Makoha FW, Felimban HM, Fathuddien MA, et al. Multiple cesarean section morbidity. Int J Gynaecol Obstet 2004; 87:227.
  18. Morales KJ, Gordon MC, Bates GW Jr. Postcesarean delivery adhesions associated with delayed delivery of infant. Am J Obstet Gynecol 2007; 196:461.e1.
  19. Uygur D, Gun O, Kelekci S, et al. Multiple repeat caesarean section: Is it safe? Eur J Obstet Gynecol Reprod Biol 2005; 119:171.
  20. Cook JR, Jarvis S, Knight M, Dhanjal MK. Multiple repeat caesarean section in the UK: incidence and consequences to mother and child. A national, prospective, cohort study. BJOG 2013; 120:85.
  21. Silver RM, Landon MB, Rouse DJ, et al. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol 2006; 107:1226.
  22. Lydon-Rochelle M, Holt VL, Easterling TR, Martin DP. First-birth cesarean and placental abruption or previa at second birth(1). Obstet Gynecol 2001; 97:765.
  23. Getahun D, Oyelese Y, Salihu HM, Ananth CV. Previous cesarean delivery and risks of placenta previa and placental abruption. Obstet Gynecol 2006; 107:771.
  24. Yang Q, Wen SW, Oppenheimer L, et al. Association of caesarean delivery for first birth with placenta praevia and placental abruption in second pregnancy. BJOG 2007; 114:609.
  25. Jackson S, Fleege L, Fridman M, et al. Morbidity following primary cesarean delivery in the Danish National Birth Cohort. Am J Obstet Gynecol 2012; 206:139.e1.
  26. National Institutes of Health Consensus Development Conference Statement. NIH consensus development conference: Vaginal birth after cesarean: New insights. March 8–10, 2010.
  27. Rossouw JN, Hall D, Harvey J. Time between skin incision and delivery during cesarean. Int J Gynaecol Obstet 2013; 121:82.
  28. Nisenblat V, Barak S, Griness OB, et al. Maternal complications associated with multiple cesarean deliveries. Obstet Gynecol 2006; 108:21.
  29. Sikirica V, Broder MS, Chang E, et al. Clinical and economic impact of adhesiolysis during repeat cesarean delivery. Acta Obstet Gynecol Scand 2012; 91:719.
  30. Eijsink JJ, van der Leeuw-Harmsen L, van der Linden PJ. Pregnancy after caesarean section: Fewer or later? Hum Reprod 2008; 23:543.