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

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.