Introducing routine trial of labour after caesarean section in a second level hospital setting

Abstract

Objective: We analysed the impact on caesarean section (CS) rate of introducing a routine trial of labour (TOL) for patients with a previous CS. Study design: During 2007 and 2008, we offered a TOL to all women with one previous CS planning to give birth in our hospital. The adherence to the procedure, success of vaginal delivery, overall CS rate, incidence of symptomatic uterine rupture and other complications were evaluated. Labour induction was allowed only using castor oil or Amniotomy. Results: One hundred and ninety-four women were considered eligible for TOL. A total of 87.6% of them agreed to undergo the procedure (78.7% in the first year versus 95.2% in the second year, p < 0.05). Of these, 63.5% delivered successfully (42.3% in the first year versus 78.8% in the second year, p < 0.05); 10.6% underwent a primary CS because of failed spontaneous labour or failed labour induction and 25.9% a secondary CS during labour. The CS rate decreased significantly from 19.6% (in 2003–2006) to 14.9% (iN 2007–2008) (p < 0.05). One case of symptomatic uterine rupture occurred, while no difference for other complications was observed. Conclusions: The CS rate decreased dramatically through introducing a TOL programme for patients with one previous CS. The possibility of symptomatic uterine rupture should be however considered and patients adequately informed.

Keywords::

• Caesarean section
• pregnancy outcome
• trial of labour (TOL)
• uterine rupture
• vaginal birth after caesarean (VBAC)

Acknowledgments

The Authors thank midwives and doctors working at Montebelluna Hospital, particularly Dott. Mauro Viani, who was responsible for changing the management policy of pregnancies after caesarean section, and Dott. Federica Da Forno, who is in charge of the obstetrical care unit. We are grateful to Eilidh P. J. McIntosh and Anna Franz for English revision and to Dott. Serena Bertozzi for valuable collaboration in reviewing process.

Declaration of Interest: The authors report no conflicts of interest.