This prospective restricted cohort study was conducted to compare risks and benefits of a planned elective repeat caesarean (ERC) with planned vaginal birth after caesarean (VBAC). Subjects included 2,345 women with one prior caesarean, eligible for VBAC at term. Women were assigned by patient preference (N = 2,323) or randomization (N = 22) to planned VBAC (1,225 patient preference, 12 randomized) or planned ERC (1,098 patient preference, ten randomized). The risk of fetal death or liveborn infant death prior to discharge or serious infant outcome was significantly lower for infants born in the planned ERC group compared with infants in the planned VBAC group (0.9% vs 2.4%; RR 0.39; 95% CI 0.19-0.80). Fewer women in the planned ERC group compared with women in the planned VBAC had a major haemorrhage, defined as blood loss ≥1,500 ml and/or blood transfusion (0.8% vs 2.3%; RR 0.37; 95% CI 0.17-0.80). The authors concluded that among women with one prior caesarean, planned ERC compared with planned VBAC was associated with a lower risk of fetal and infant death, serious infant outcome, and major maternal haemorrhage, with no increase in maternal or perinatal complications to time of hospital discharge. PLoS Med. 2012 Mar;9(3):e1001192. PMID: 22427749
