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Pregnant women with one or two prior cesarean deliveries with a low transverse uterine incision face the important decision of whether to attempt a trial of labor after cesarean (TOLAC) or schedule an elective repeat cesarean delivery. To explore the relative risks and benefits of these options, investigators retrospectively studied nearly all hospital deliveries in Canada from April 2003 through March 2015, including 197,540 women with singleton term pregnancies and one prior cesarean delivery. Of these, 138,836 chose repeat cesarean delivery and 58,704 chose TOLAC. Among those selecting TOLAC, about 50% had successful vaginal deliveries.
Incidence of severe maternal morbidity was significantly greater with TOLAC than with repeat cesarean d…