Outcome of trial of labor and causes of its failure in patients with previous one lower segment caesarean section

Abstract

Introduction: As per guideline of American College of Obstetricians and Gynecologists, repeat cesarean section should be avoided unless there is absolute contraindication. However, in patients having previous c-section, the trial of oxytocin/
prostaglandin for induction of labor has controversial report.
Objectives: To determine the outcome of the trial of labor and causes of its failure
in patients with a previous one lower segment cesarean section.
Methodology: This descriptive cross-sectional study was conducted at Department
of Obstetrics & Gynecology at Peoples Medical College Hospital, Nawabshah for the
period of six months from January 2021 to June 2021. During this period 100 patients, aged 20-45 years, with term gestation and history of previous lower segment
cesarean section, having vertex presentation singleton pregnancy were included.
Results: The mean age of 100 enrolled patients was 34.69 ±1.44 years. Trial of labor
found successful in 64 women; in 45 (70.3%) there was spontaneous vaginal delivery, 14(21.8%) had forceps delivery and 5 (7.8%) had vacuum delivery. Among 36
patients where trial of labor remained unsuccessful, cesarean section was performed. The trial of labor was failed secondary to failed progress of labor (n= 17,
47.2%), fetal distress (n=11, 30.5%), scar dehiscence (n=3, 8.3%) and antepartum
hemorrhage (n=5,13.8%). There was no mortality of fetus or mother in our study.
Conclusion: Trial of labor should always be attempted in women with previous cesarean sections with continuous monitoring, provided there is no absolute contraindication, as it may be successful in most cases.

Keywords: Cesarean Section, Trial of Labor, Failure, lower segment