{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T12:04:05Z","timestamp":1791288245291,"version":"4.3.0"},"reference-count":45,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T00:00:00Z","timestamp":1769644800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T00:00:00Z","timestamp":1769644800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The global cesarean section (CS) rate has increased to 21.1% between 1990 and 2018. In Singapore, the annual CS rate has increased by ~\u20090.6%, reaching an overall rate of 37.4%. Almost one\u2010third of all cesarean deliveries are performed for at least one previous CS. Women with two CSs are often denied a \u201ctrial of vaginal delivery\u201d due to the increased risk of uterine scar rupture. This study aims to examine maternal and neonatal outcomes of women undergoing trials of labor following two CSs (TOLAC\u20102).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective observational study of women with singleton, term pregnancies in cephalic presentation who underwent TOLAC\u20102 at the National University Hospital, Singapore, between September 2013 and June 2022. Data were obtained through a detailed review of electronic medical records.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 898 women with two previous CSs, 7.0% (63\/898) attempted TOLAC\u20102, of whom 55.6% (35\/63) achieved a successful vaginal birth (VBAC\u20102). Successful TOLAC\u20102 was associated with a significantly shorter duration of active labor (5.0 vs. 7.7\u2009h,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.013) and lower estimated blood loss (242mLs vs. 423mLs,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009\u2264\u20090.001) compared with failed TOLAC\u20102. There were no perinatal complications of uterine rupture, APGAR &lt;7 at 5\u2009minutes, meconium aspiration syndrome or hypoxic\u2013ischemic encephalopathy. We observed a trend toward successful VBAC\u20102 in women with a history of prior vaginal birth (74.6% vs. 48.9%\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.07).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In our cohort, more than half of the women attempting TOLAC\u20102 at term achieved a successful vaginal birth without serious perinatal or maternal complications. TOLAC\u20102 is a safe and reasonable option for appropriately selected women following adequate counseling, even in the absence of a prior vaginal delivery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aogs.70092","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T17:41:21Z","timestamp":1769708481000},"page":"519-527","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Nine years' experience of trial of labor after two previous cesarean sections at a tertiary hospital \u2013 A retrospective cohort study"],"prefix":"10.1111","volume":"105","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2368-8330","authenticated-orcid":false,"given":"Kelvin Z. X.","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology National University Health System  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Binny Priya","family":"Sesurajan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine National University of Singapore  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harshaana","family":"Ramlal","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology National University Health System  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tak Yein","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology National University Health System  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahesh","family":"Choolani","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology National University Health System  Singapore Singapore"},{"name":"Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine National University of Singapore  Singapore Singapore"},{"name":"Department of Obstetrics and Gynaecology National University Centre for Women and Children (NUWoC)  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanaja","family":"Kalaichelvan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology National University Health System  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin Lin","family":"Su","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology National University Health System  Singapore Singapore"},{"name":"Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine National University of Singapore  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ida","family":"Ismail\u2010Pratt","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Mount Elizabeth Novena  Singapore Singapore"},{"name":"Society of Colposcopy &amp; Cervical Pathology Singapore (SCCPS)  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0068-6957","authenticated-orcid":false,"given":"Citra N. Z.","family":"Mattar","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology National University Health System  Singapore Singapore"},{"name":"Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine National University of Singapore  Singapore Singapore"},{"name":"Department of Obstetrics and Gynaecology National University Centre for Women and Children (NUWoC)  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah W. L.","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology National University Health System  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,1,29]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2021-005671"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0148343"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/birt.12341"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002494"},{"key":"e_1_2_13_6_1","first-page":"1","article-title":"Conservatism in obstetrics","volume":"104","author":"Cragin EB","year":"1916","journal-title":"New York Med J"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clp.2011.03.005"},{"key":"e_1_2_13_8_1","volume-title":"WHO Recommendations Non\u2010Clinical Interventions to Reduce Unnecessary Caesarean Sections","author":"World Health Organization","year":"2018"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2008.04.025"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1542-2011.2011.00106.x"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.287.20.2684"},{"key":"e_1_2_13_12_1","unstructured":"RCOG.Green\u2010Top Guideline No. 45 \u2010 Birth After Previous Caesarean Birth. Royal College of Obstetricians and Gynaecologists.2015."},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000003078"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2009.02351.x"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wombi.2019.03.001"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.18332\/ejm\/205874"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/jog.12608"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2024.2326301"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.47102\/annals-acadmedsg.202132"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-023-05348-4"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-018-1661-0"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1080\/07853890.2021.1959049"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2022.10.030"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2018.1520831"},{"key":"e_1_2_13_25_1","doi-asserted-by":"publisher","DOI":"10.5603\/GP.2019.0076"},{"key":"e_1_2_13_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/s43032-020-00378-1"},{"key":"e_1_2_13_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/jog.15351"},{"key":"e_1_2_13_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.14665"},{"key":"e_1_2_13_29_1","first-page":"e2636","article-title":"The feasibility of a trial of labor after two cesarean deliveries: outcomes and prognostic factors for success","volume":"41","author":"Lopian M","year":"2023","journal-title":"Am J Perinatol"},{"key":"e_1_2_13_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2023.05.038"},{"key":"e_1_2_13_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2024.05.020"},{"key":"e_1_2_13_32_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000224694.32531.f3"},{"key":"e_1_2_13_33_1","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare11202799"},{"issue":"3","key":"e_1_2_13_34_1","first-page":"300","article-title":"VBAC: antenatal predictors of success","volume":"90","author":"Trojano G","year":"2019","journal-title":"Acta Biomed"},{"key":"e_1_2_13_35_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0040-1714344"},{"key":"e_1_2_13_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2013.06.014"},{"key":"e_1_2_13_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2012.11.008"},{"key":"e_1_2_13_38_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2018.1551352"},{"key":"e_1_2_13_39_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.12010"},{"key":"e_1_2_13_40_1","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.19.236729"},{"key":"e_1_2_13_41_1","volume-title":"WHO Recommendations on Intrapartum Care for a Positive Childbirth Experience","author":"World Health Organization","year":"2018"},{"key":"e_1_2_13_42_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-021-03615-w"},{"key":"e_1_2_13_43_1","doi-asserted-by":"publisher","DOI":"10.1111\/jog.15056"},{"key":"e_1_2_13_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogc.2021.11.015"},{"key":"e_1_2_13_45_1","doi-asserted-by":"publisher","DOI":"10.3109\/14767051003678176"},{"key":"e_1_2_13_46_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-024-06921-1"}],"container-title":["Acta Obstetricia et Gynecologica Scandinavica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/aogs.70092","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/aogs.70092","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/aogs.70092","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T00:24:26Z","timestamp":1773188666000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1111\/aogs.70092"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,29]]},"references-count":45,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1111\/aogs.70092"],"URL":"https:\/\/doi.org\/10.1111\/aogs.70092","archive":["Portico"],"relation":{},"ISSN":["0001-6349","1600-0412"],"issn-type":[{"value":"0001-6349","type":"print"},{"value":"1600-0412","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,29]]},"assertion":[{"value":"2025-05-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-15","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-29","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}