MATERNAL-FETAL MEDICINE Second stage disorders in patients following a previous cesarean section: vacuum versus repeated cesarean section Roy Kessous • Dan Tirosh • Adi Y. Weintraub • Neta Benshalom-Tirosh • Ruslan Sergienko • Eyal Sheiner Received: 19 October 2012 / Accepted: 11 December 2012 / Published online: 30 December 2012 Ó Springer-Verlag Berlin Heidelberg 2012 Abstract Objective To investigate whether vacuum extraction due to failure of labor to progress (dystocia) during the second stage in a delivery following a previous cesarean section (CS) is related to increased adverse maternal and perinatal outcomes as compared with repeated CS. Study design A retrospective cohort study of pregnancy and delivery outcomes of patients in their second deliveries attempting a vaginal birth after cesarean (VBAC) follow- ing one CS was conducted. Patients who delivered by vacuum extraction were compared with patients who underwent a repeated CS for failure of labor to progress during the second stage. Results During the study period, 319 patients with a previous CS suffered from a prolonged second stage of labor in their second delivery. Of these, 184 underwent vacuum extraction and 135 patients underwent a repeated CS. No significant differences in relevant pregnancy complications such as perineal lacerations, uterine rupture, and post-partum hemorrhage and perinatal outcomes were noted between the groups. There were no cases of perinatal mortality in our study. Conclusion When managing second stage labor disor- ders, vacuum extraction does not seem to be an unsafe procedure in patients with a previous CS. Keywords Cesarean section Á Vacuum extraction Á Prolonged second stage Á Vaginal birth after cesarean Introduction In recent years, the number of cesarean deliveries is rising, reaching a rate as high as 25–30 % in developed countries [1]. This increase is associated with changing trends in obstetrical practice and with certain demographic, clinical, and social factors including increasing maternal age, electronic fetal heart rate monitoring, a decrease in the rate of instrumental deliveries, an increase in the rate of pri- mary (cesarean section) CS due to breech presentation, a decrease in vaginal birth after cesarean (VBAC), increased obesity, and an increase in medically indicated labor inductions [1]. Notably, this increase in the rate of CS results in turn in a higher rate of recurrent CS. The rate of operative vaginal delivery has decreased in recent years reaching 4–5 % of all deliveries [2]. The most common instrumental delivery method presently utilized is vacuum extraction (3–4 %), while delivery by forceps is relatively rare (less than 1 %) [2]. Among the reasons for the decline in instrumental deliveries are the related com- plications, fear of legal consequences, and lack of training of the medical staff in such procedures [3]. The rate of VBAC has increased up to 25 % in the mid 1990s; however, troubling reports about complications [4, 5] have resulted in a decline in the rate of VBAC to less than 10 % in the USA in the last decade [1]. Interestingly, this decrease did not affect other countries reviewed in the same survey, R. Kessous Á D. Tirosh Á A. Y. Weintraub Á N. Benshalom-Tirosh Á E. Sheiner (&) Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, POB 151, Beer-Sheva 84101, Israel e-mail: sheiner@bgu.ac.il R. Kessous e-mail: kessousr@bgu.ac.il R. Sergienko Epidemiology and Health Services Evaluation, Ben-Gurion University of the Negev, Beer-Sheva, Israel 123 Arch Gynecol Obstet (2013) 287:1075–1079 DOI 10.1007/s00404-012-2688-5