Trial of labour after a previous caesarean section delivery: a private hospital experience

Background: In an attempt to reduce the rising trend of caesarean deliver worldwide, obstetrician now offer trial of labour more readily to women who have had a caesarean section. Although trial of labour is usually successful and safe, it may occasionally be associated with severe morbidity and even mortality. In this report, we audited all cases of trial of labour after a previous caesarean delivery in our hospital. Method: A three year (2000 – 2003) prospective study of all cases of trial of labour after one previous caesarean section at the Havana Specialist Hospital Lagos. Results: Of the 1481 deliveries in our hospital during the period, 179(11.9%) had previously been delivered through caesarean section. While 29.3% (51) of the women with previous caesarean delivery had elective caesarean section, 70.7% (123) were allowed trial of labour. Eighty five (69.1%) women had successful trial of labour. The failure rate was thus 30.9%. Cephalopelvic disproportion and slow progress of labour was the main cause of failure. Majority (58.8%) of the patients that achieved vaginal deliver needed assistance in the form of vacuum delivery (40.0%), vacuum deliver & episiotomy (30.0%), episiotomy alone (28.0%) and forceps deliver (2.0%). When fetal and maternal outcome were compared between emergency and elective caesarean section, it was only in Apgar score at 1 minute was there significant difference. One (0.8%) uterine rupture occurred because of delayed consent and she was not among the eight patients that had oxytocin augmentation of labour. Conclusion: In countries where caesarean section are not readily acceptable, flexibility within the frame work of good obstetric practice is the desired goal. However labour in women with scarred uterus must be conducted in institution that have facilities for emergency obstetric services. This study has shown that trial of labour in patient with one previous caesarean section is not only feasible but practicable and oxytocin augmentation is safe when judiciously used