Factors Affecting the Success of Trial of Labour after Previous Caesarean Delivery

Original article


Yousef Bashir Gadmour ¹, Fathia Ali Godid ²

1-Department of Obstetrics and Gynaecology, Faculty of Medicine, Al-Fateh University, Tripoli , Libya 2- Department of Obstetric and Gynaecology, Zawia Hospital, Zawia, Libya

JMJ 2010,Vol. 10, No.1:34-39


Objective: The purpose of this study is to determine which factors influence the likelihood of a successful trial of a labour (TOL) after one previous caesarean delivery (C/D), and determine its complication rate . Setting: Zawia Teaching Hospital; Zawia city; Libya. Design: An observational retrospective cohort study. Patients, Methods and Materials: The study was conducted from April 2005 to April 2006, there were 498 pregnant women with previous one (C/D), 434 were underwent (TOL), and the other 64 women were dropped from the study because they were delivered by an elective caesarean section. The data of this study were collected from patients’ files, labour registry books, and operation notes. The analysis included all women with singleton or multiple gestation of at least 37 weeks gestation, past obstetric history, including indication of the previous (C/D) history of previous vaginal delivery or vaginal birth after caesarean (VBAC), and the presence of maternal diseases such as hypertension, diabetes mellitus, bronchial asthma, renal disease, and thyroid disease were recorded. Obstetric factors related to the present pregnancy included birth weight, gestational age, foetal gender, type of labour (spontaneous, induced, or augmented), cervical dilation on admission and at the time of decision for (C/D), and duration of the first stage of labour. Complications of cases which attempted (VBAC), were recorded these included fever, urinary tract infections (UTI), post partum haemorrhage (PPH), and anaemia. Complications which developed in women who underwent C/S as intra-operative complications, blood transfusion, and postoperative complications such as ( fever, wound infection , post partum haemorrhage ), were recorded. Results: Four hundred and thirty four women with previous one (C/D) underwent (TOL), with 221 (50.9 %) achieving successful VBAC. One hundred and nine women with previous VBAC had the highest success rate (84.5%) compared with 38(30.2%) women without such a history. One hundred forty seven women with previous vaginal delivery had high success rate of (65.9%) compared with (33.4 %) in 74 women who had not such history. TOL success rates were affected by previous indication for C/D. The success rates were as follow; (55.4%) when malpresentation was a previous indications, spontaneous labour ( 53.7% ) , cervical dilation > 4 cm on admission ( 71.9% ), birth weight < 4000 gm (69.8% ), and gestational age 37-40 weeks ( 69.6% ). Overall the women, who attempted (VBAC) had less complications than those who failed TOL (3.6%, 17.8%) respectively. Conclusion: Previous caesarean delivery is still a warning condition, it is considered as a high- risk case in the obstetric filed, due to the dangerous complication which is in ruptured uterus despite the risks (0.5 - 1 % rate of uterine rupture), a trial of labour after caesarean delivery remains an attractive option for many patient and leads to a successful outcome in a high proportion of cases. In comparison, the alternative of elective repeat caesarean delivery is not without risks. There are indicators of successful TOL, previous vaginal delivery, and previous VBAC were found to be the most significant predicators of VBAC success. Cervical dilation and ripening at onset of labour, spontaneous onset of labour, last caesarean delivery more than two years, indication of previous C/S not dystocia, good foeto- maternal condition, were important indicators of TOL success . Keywords: Trial of labour (TOL), Previous caesarean delivery (C/D), Vaginal birth after caesarean (VBAC). Link/DOI: http://www.jmj.org.ly/images/stories/spring2010/34.pdf