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Trial of labour after previous caesarean section in rural Zimbabwe
W A Spaans1, F H van der Velde, J van Roosmalen
1Academic Medical Centre, Department of Obstetrics and Gynaecology, Amsterdam, Netherlands.
Objective:
Vaginal delivery after previous caesarean section is widely accepted in Western countries. Is a trial of labour in rural Africa also safe for mother and child?
Study Design:
In a case control study in rural Zimbabwe the outcome of labour of 281 women who had one or more previous caesarean sections was compared with 4501 women who had no previous caesarean section. Maternal and perinatal mortality, the percentage of vaginal birth and factors related to the achievement of vaginal delivery were studied. Data were tested for statistical significance with a Mantel-Haenszel equation for odds ratio's.
Results:
No elective caesarean sections were performed. After previous caesarean section, 124 (44%) out of 281 women had a vaginal birth. One scar rupture occurred in a woman with thyrotoxicosis. Perinatal and maternal outcome did not differ significantly between cases and controls. A history of more than one previous caesarean section (Odds Ration (OR) = 10.0; 95% Confidence Interval (CI95%) = 4.4-23.8) or a previous caesarean section for cephalopelvic disproportion (OR = 6.2; CI95% 3.2-120) increased the risk for a repeat caesarean section significantly.
Conclusion:
A policy to allow all women a trial of labour after a previous caesarean section did not increase adverse pregnancy outcome. Also in rural Africa it seems rational to encourage a trial of labour after one or more previous caesarean sections.