Trial of labour after previous caesarean section: obstetric outcome

Abstract

Of 305 patients with a previous lower segment Caesarean section scar admitted over a 28-month period, 207 were allowed a trial of labour. A successful trial of labour was achieved in 63.3% of patients with a recurrent indication and 73.4% with a nonrecurrent indication. Of 75 patients who received oxytocin for augmentation and 22 for induction of labour, 70.5% achieved vaginal delivery. This was similar to the vaginal delivery rate in patients who did not require augmentation in induction. Three cases of scar dehiscence occurred in patients who had oxytocin, but in whom the recommended management protocol was ignored. The events that led to these 3 dehiscences is described. Analysis of birth-weights revealed a trend towards more repeat Caesareans with increasing birth-weight beyond 2,500 g. This was especially reflected by the higher emergency Caesarean section rate in those who had a trial of labour. A trial of labour in patients with a previous Caesarean scar is safe, and can be allowed even in patients who had the previous Caesarean for cephalopelvic disproportion, although malpresentation and obvious disproportion must be excluded. Judicious use of oxytocin for a limited period of time should help in reducing the number of repeat Caesarean sections.