Trial of labour following prior section; a 5 year prospective study (1982-1987)

Between 1982 and 1987, 506 women previously delivered by Caesarean section were subjected to a trial of labour. Vaginal delivery was achieved in 78.6% with only 1 true rupture of the scar (0.2%). There were no intrapartum or neonatal deaths. Moreover, 7 of the 8 antepartum stillbirths were due to asphyxia, and, as the perinatal mortality rate for the study group was higher than for the overall population, the need for antenatal surveillance in previously sectioned patients is emphasized. Induction of labour was performed in 127 patients with 74.1% achieving vaginal delivery. Oxytocin was administered to 162 patients for either induction or augmentation of labour and 80.3% had a vaginal delivery, with 1 true rupture and 4 bloodless dehiscences. It is concluded that trial of labour following prior section is associated with little risk of true rupture, and with no added risk to the fetus. Our policy and management has helped maintain over the past 5 years an overall moderate Caesarean section rate (10-11%) with a low perinatal mortality rate.