Trial of labor versus elective repeat cesarean section for the women with a previous cesarean section: a decision analysis

In order to reduce the cesarean-delivery rate, more and more pregnant women are offered trials of labor (TOL) after their previous cesarean sections. TOL and elective repeat cesarean section (ERCS) have different risks and benefits. We constructed a decision analysis to explore this issue. Probabilities were derived from literature reviews. Health state utilities were derived from the authors' clinical judgement. The analysis considered the disutility of the procedures and the disutilities of the morbidity. Using the baseline assumption, ERCS was superior to TOL. One-way sensitivity analyses showed that the result was insensitive to all of the probability estimates and the disutilities of the morbidity. However, the result was sensitive to the patient's preference for ERCS, successful TOL, or failed TOL. The analysis indicates that the best delivery method for a woman who has had a previous cesarean section depends on patient's preference. More patients' preference studies are needed.