Mode of delivery after one caesarean section: audit of current practice in a health region.
OBJECTIVE
To audit the subsequent obstetric management of women who had had one previous baby delivered by caesarean section.


METHODS
Retrospective analysis of a regional obstetric database.


METHODS
Data derived from the 17 obstetric units in North West Thames region.


METHODS
1059 women who delivered a singleton fetus of at least 37 weeks' gestation with a cephalic presentation in 1988 who had a history of one previous caesarean section and no other deliveries.


METHODS
Mode of delivery, postnatal morbidity, and duration of hospital stay.


RESULTS
395 (37%) women were delivered by elective repeat caesarean section and 664 (63%) were allowed a trial of labour. Maternal height and birth weight of the previous infant differed significantly between those who were and those who were not allowed to labour. 471 (71%) of those allowed to labour achieved a vaginal delivery. In individual units there was no significant correlation between the proportion of patients allowed to labour and the rate of the successful trial of labour. There was a trend towards greater success rates in units that allowed a longer duration of labour (p less than 0.05) and units with greater use of oxytocin for augmentation of labour (not significant). Both elective and intrapartum caesarean section was associated with a significantly higher rate of postnatal infection than vaginal delivery (14.7% and 16.0% v 3.4%).


CONCLUSIONS
In patients with a history of caesarean section there is no evidence that the likelihood of successful vaginal delivery after trial of labour is modified by the proportion of such patients allowed the option of attempted vaginal delivery. Until selection criteria of adequate prognostic value can be identified a more liberal approach to allowing women a trial of labour seems justified.
Academic Department of Obstetrics and Gynaecology, Imperial College of Science, Technology and Medicine, St Mary's Hospital Medical School, London.
C M
CM
Paterson
N J
NJ
Saunders
D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007751:Labor, Induced; D007902:Length of Stay; D008485:Medical Audit; D011247:Pregnancy; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D014219:Trial of Labor; D016064:Vaginal Birth after Cesarean / Q000706:statistics & numerical data