[Labor management following previous cesarean section]

Between January 1, 1982 and March 31, 1984, 300 patients were delivered at Graz Gynaecological Clinic who had undergone Caesarean section during their previous delivery or deliveries at the clinic. It was possible to deliver 166 patients (55.3%) of their children vaginally. The rate of spontaneous labour was as high as 91.8% in a group of 61 women who had given birth vaginally once or several times either before or since the Caesarean section. Successful vaginal delivery occurred in 73.5% or 80.6% if the indication for the previous Caesarean section was a breech presentation or a foetal distress, and in 31.7% or 30.6% of those patients whose indication for their previous Caesarean section was a cephalopelvic disproportion or a prolonged labour. The Caesarean section had to be repeated in a total of 134 parturients (44.7%). Of these, the second Caesarean section was indicated primarily (electively) in 29.1%, secondarily in 70.9%. A rupture in the area of the old Caesarean scar occurred in 5 out of 300 cases (1.7%). In four cases this was diagnosed intraoperatively, and once during post partum palpation of the uterine cavity.