Vaginal delivery after three previous caesarean sections: A report of two cases

Vaginal birth after one caesarean section (CS) is considered safe in selected women. However, women with more than one CS in low-income settings are at higher risk of complications with vaginal birth. Thus, abdominal delivery is recommended for women with more than one CS in low-income countries unlike in high-income countries. This study was designed to raise awareness on the remote possibility of safe vaginal delivery after three CS in low-income countries. The records of two women who had vaginal deliveries after three previous CS were retrieved and reviewed. Both women presented in advanced labour and had unplanned but successful vaginal deliveries. There was no uterine rupture. The risks and consequences of uterine rupture may outweigh the benefits of unplanned vaginal birth after more than one CS. These unusual cases suggest the remote possibility of success and the need for further studies on defining safety guidelines for low-resource settings.