Although the risk of uterine rupture and fetal complications may be slightly increased with a trial of labor (TOL), the overall incidence of these complications is low.
In a recent meta-analysis involving 47,682 women, a TOL produced more favorable maternal outcomes than elective repeat cesarean (ERC). Women choosing TOL also were much less likely to undergo hysterectomy than those selecting ERC.
Many investigators remain reluctant to recommend induction of labor in the setting of vaginal birth after cesarean section (VBAC), fearing an increased risk of uterine rupture when oxytocic agents are used.
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.