Outcome of spontaneous labour in multigravidae

Abstract

From a study of 2000 consecutive labours, the outcome of 847 multigravid patients admitted in spontaneous labour was examined. Labour was classified according to the cervimetric pattern, and response to oxytocin given according to a strict protocol with the use of a nomogram and partogram. The mean 'observed first stage' was 3.4 h, and the caesarean section rate 1.4%. Normal labour occurred in 88.5%, with a vaginal delivery rate of 99.5% in this group. Stimulation was indicated in 98 patients (11.6%), augmentation improving the rate of progress in 86 (87.8%) of these, with vaginal delivery occurring in all but one. Successful accelerated labour was not associated with any increase in neonatal morbidity as judged by Apgar scores, intubation or transfer to the special care baby unit. Twelve patients did not have improvement following augmentation and seven were delivered by caesarean section, including one following a potentially preventable uterine rupture. The greatest neonatal morbidity was in the group with primary dysfunctional labour that did not improve with augmentation. It may be that this was related to the mode of delivery rather than augmentation, as there was no significant difference in neonatal condition between normal and abnormal labour if vaginal delivery occurred.