{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:40:06Z","timestamp":1791506406717,"version":"4.3.4"},"reference-count":23,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T00:00:00Z","timestamp":1755129600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Worldwide, numbers of repeat cesarean sections continue to rise. Although there is a multitude of evidence about the safety of a vaginal delivery attempt after one cesarean section, data is scarce regarding the risks of one compared to two prior procedures. This study aims to determine whether vaginal childbirth is less safe and successful for both mother and child in patients with a history of two cesarean sections compared to those with only one.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>This retrospective cohort study included all patients with a history of one or two prior cesarean deliveries who gave birth at term at Goethe University Frankfurt between 2014 and 2021. Maternal and neonatal morbidity, as well as rates of success for vaginal birth and uterine rupture, were compared between the groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 1967 women studied, 1697 gave birth after one previous cesarean section, while 270 had a history of two prior cesarean sections. There was no significant increase in maternal or fetal morbidity in women with two previous cesarean sections compared to one. However, the success rate of a vaginal delivery was lower in the group with two prior cesareans (27\/79, 34.2%) than in the group with one (696\/989, 70.3%). The rate of complete uterine rupture was higher in patients with two cesareans who underwent cesarean section after onset of labor (CSAOL-2: 3\/89, 3.4%) compared to none in the CSAOL-1 group (0\/492, 0.0%; p\u2009=\u20090.004). Maternal and fetal morbidity remained comparable across groups, with NICU admission rates of 11.2% (CSAOL-1) vs. 5.6% (CSAOL-2), and maternal transfusion rates of 0.86% (VBAC-1) vs. 6.45% (VBAC-2).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In the context of patient autonomy regarding the timing of delivery, offering the patient the choice of different delivery modes after two previous cesareans appears to be safe with respect to maternal and fetal risks. An individualized consultation and thorough counseling are essential, but the opportunity for different delivery options should be respected and supported.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0330216","type":"journal-article","created":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T17:28:06Z","timestamp":1755192486000},"page":"e0330216","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Is it safe for women with a history of two cesarean deliveries to undergo a vaginal delivery attempt in comparison to patient with a history of one cesarean delivery?"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-1620-5577","authenticated-orcid":true,"given":"Anna Elisabeth","family":"Hentrich","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4799-3391","authenticated-orcid":true,"given":"D\u00f6rthe","family":"Br\u00fcggmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samira Catharina","family":"Hoock","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eileen","family":"Deuster","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jakob Thomas","family":"Buslowicz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliane","family":"Bresgen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadja","family":"Zander","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Louwen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6919-9394","authenticated-orcid":true,"given":"Lukas","family":"Jennewein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,8,14]]},"reference":[{"issue":"3","key":"pone.0330216.ref001","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1002\/ijgo.14854","article-title":"Delivery after a previous cesarean section reviewed","volume":"163","author":"MJ Turner","year":"2023","journal-title":"Int J Gynaecol Obstet"},{"issue":"2","key":"pone.0330216.ref002","article-title":"ACOG Practice Bulletin No. 205: Vaginal Birth After Cesarean Delivery","volume":"133","year":"2019","journal-title":"Obstet Gynecol"},{"key":"pone.0330216.ref003","unstructured":"Deutsche Gesellschaft f\u00fcr Gyn\u00e4kologie und Geburtshilfe (DGGG). Sectio caesarea AWMF 015-084 Leitlinie S3 Version 1, Stand Juni 2020. n.d."},{"key":"pone.0330216.ref004","unstructured":"RCOG GGN. Birth After Previous Caesarean Birth Green -top Guidelines No.45 October 2015. n.d."},{"issue":"12","key":"pone.0330216.ref005","article-title":"Planned elective repeat caesarean section versus planned vaginal birth for women with a previous caesarean birth","volume":"2013","author":"JM Dodd","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"key":"pone.0330216.ref006","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.ejogrb.2022.04.006","article-title":"Women\u2019s views and preferences regarding the mode of birth after cesarean section: Polish cross-sectional web-based survey","volume":"273","author":"D Sys","year":"2022","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"issue":"2","key":"pone.0330216.ref007","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1002\/uog.12479","article-title":"Sonographic measurement of lower uterine segment thickness to predict uterine rupture during a trial of labor in women with previous Cesarean section: a meta-analysis","volume":"42","author":"N Kok","year":"2013","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"1","key":"pone.0330216.ref008","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1097\/01.AOG.0000224694.32531.f3","article-title":"Risk of uterine rupture with a trial of labor in women with multiple and single prior cesarean delivery","volume":"108","author":"MB Landon","year":"2006","journal-title":"Obstet Gynecol"},{"issue":"4","key":"pone.0330216.ref009","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.1016\/j.ajog.2004.12.082","article-title":"Obstetric outcomes in women with two prior cesarean deliveries: is vaginal birth after cesarean delivery a viable option?","volume":"192","author":"GA Macones","year":"2005","journal-title":"Am J Obstet Gynecol"},{"key":"pone.0330216.ref010","doi-asserted-by":"crossref","first-page":"920647","DOI":"10.3389\/fmed.2022.920647","article-title":"Planned mode of birth after previous cesarean section: A structured review of the evidence on the associated outcomes for women and their children in high-income setting","volume":"9","author":"KE Fitzpatrick","year":"2022","journal-title":"Front Med (Lausanne)"},{"issue":"2","key":"pone.0330216.ref011","doi-asserted-by":"crossref","DOI":"10.9778\/cmajo.20140055","article-title":"Maternal and newborn outcomes after a prior cesarean birth by planned mode of delivery and history of prior vaginal birth in British Columbia: a retrospective cohort study","volume":"3","author":"CD Bickford","year":"2015","journal-title":"CMAJ Open"},{"issue":"25","key":"pone.0330216.ref012","doi-asserted-by":"crossref","first-page":"2581","DOI":"10.1056\/NEJMoa040405","article-title":"Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery","volume":"351","author":"MB Landon","year":"2004","journal-title":"N Engl J Med"},{"issue":"4","key":"pone.0330216.ref013","doi-asserted-by":"crossref","first-page":"872","DOI":"10.1016\/S0002-9378(99)70317-0","article-title":"Rate of uterine rupture during a trial of labor in women with one or two prior cesarean deliveries","volume":"181","author":"AB Caughey","year":"1999","journal-title":"Am J Obstet Gynecol"},{"issue":"9","key":"pone.0330216.ref014","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1002913","article-title":"Planned mode of delivery after previous cesarean section and short-term maternal and perinatal outcomes: A population-based record linkage cohort study in Scotland","volume":"16","author":"KE Fitzpatrick","year":"2019","journal-title":"PLoS Med"},{"key":"pone.0330216.ref015","first-page":"1","article-title":"Vaginal birth after cesarean: new insights","author":"J-M Guise","year":"2010","journal-title":"Evid Rep Technol Assess (Full Rep)"},{"issue":"1","key":"pone.0330216.ref016","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1111\/j.1471-0528.2009.02351.x","article-title":"Vaginal birth after two caesarean sections (VBAC-2)-a systematic review with meta-analysis of success rate and adverse outcomes of VBAC-2 versus VBAC-1 and repeat (third) caesarean sections: Success rate & adverse outcomes of vaginal birth after two caesarean sections","volume":"117","author":"S Tahseen","year":"2010","journal-title":"BJOG"},{"issue":"1","key":"pone.0330216.ref017","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1186\/s12884-024-06763-x","article-title":"Trial of labour after two caesarean sections (TOLA2C) and risk of uterine rupture, a retrospective single centre study","volume":"24","author":"S Denjean","year":"2024","journal-title":"BMC Pregnancy Childbirth"},{"key":"pone.0330216.ref018","doi-asserted-by":"crossref","DOI":"10.5772\/intechopen.86334","article-title":"Maternal and Fetal Risks in Higher Multiple Cesarean Deliveries.","author":"C Zwergel","year":"2020","journal-title":"Recent Advances in Cesarean Delivery. 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