BMJ  2007;335:7 (7 July), doi:10.1136/bmj.39262.430706.3A

Letters

Deciding on caesarean section

Vaginal birth after a caesarean is not always beneficial

The first 150 words of the full text of this article appear below.

The study by Montgomery et al and the accompanying editorial are based on the premise that vaginal delivery after one caesarean section is necessarily a beneficial and desirable objective or outcome.^{1 2} However, the risks and benefits as published in the recent RCOG (Royal College of Obstetricians and Gynaecologists) guidelines³ can be summarised as follows:

Risks

• Uterine rupture 22–74/10 000.
  
• 1% increase in risk of endometritis (289/10 000 versus 180/10 000).
  
• 1% increase in need for blood transfusion (170/10 000 versus 100/10 000).
  
• 2–3/10000 additional risk of birth-related perinatal death compared with planned caesarean section.
  
• Increased risk of antepartum stillbirths after 39 weeks with an overall increase in perinatal mortality at term.
  
• 8/10 000 risk of hypoxic ischaemic encephalopathy, which may have long term developmental implications.
  

Benefits

• Probable reduction in risk of neonatal respiratory problems: 2-3% with planned vaginal delivery after one caesarean section and 3-4% with caesarean section
  
• Caesarean section . . . [Full text of this article]

John Radcliffe Hospital, Oxford OX3 9DU

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