What is the expected cesarean (C-section) rate for multiparous women with singleton cephalic fetuses who have had previous vaginal deliveries?

Cesarean Rate in Multiparous Women with Singleton Cephalic Fetuses and Previous Vaginal Deliveries

The cesarean delivery rate for multiparous women with singleton cephalic fetuses who have had previous vaginal deliveries is expected to be very low, approximately 4.7% based on the most recent evidence. 1

Factors Influencing Low Cesarean Rates in This Population

• Previous vaginal delivery is one of the strongest predictors of successful vaginal birth in subsequent pregnancies 2
• Multiparous women with previous vaginal deliveries have significantly higher rates of successful vaginal birth compared to nulliparous women 2
• Having had a previous vaginal birth is linked with higher rates of successful vaginal delivery in subsequent pregnancies 2

Specific Cesarean Rates by Population

• For multiparous women with singleton cephalic fetuses who have had previous vaginal deliveries only (no previous cesarean), the cesarean rate is approximately 4.7% 1
• In contrast, nulliparous women have significantly higher cesarean rates of approximately 15.9% 1
• The primary cesarean delivery rate for all multiparous women (including those without previous vaginal births) is 11.5% 3

Indications for Cesarean in This Low-Risk Population

When cesareans do occur in multiparous women with previous vaginal deliveries, the most common indications include:

• Dystocia (failure to progress), which accounts for only about 1.3% of deliveries in multiparous women with previous vaginal births 1
• Non-reassuring fetal heart rate tracings 3
• Malpresentation that develops during labor (not pre-existing breech) 3

Clinical Implications

• Physicians should be aware that cesarean delivery in this population is uncommon and should maintain a high threshold for intervention 2
• When counseling multiparous women with previous vaginal deliveries about their delivery options, they should be informed of their high likelihood of successful vaginal birth 2
• Even in cases where complications such as breech presentation occur, multiparous women with previous vaginal deliveries have high success rates (75.8%) for vaginal delivery if they are candidates for it 4

Potential Complications to Monitor

• While cesarean rates are low in this population, vigilance is still required for:
  • Abnormal placentation in those with any previous uterine surgery 2
  • Monitoring for labor disorders or non-reassuring fetal heart rate patterns, which account for most of the small percentage of cesareans in this group 4

Key Takeaway

Multiparous women with singleton cephalic fetuses who have had previous vaginal deliveries represent one of the lowest risk groups for cesarean delivery, with expected rates of approximately 4.7%. This information is valuable for counseling patients and for clinical decision-making during labor management.