ABSTRACT
A disciplined approach to labor management has resulted in a low cesarean rate (9%)
in our population. We wondered if this management scheme was applicable and safe applied
to women with previous cesareans. Women with a previous cesarean delivering in a 5-year
period were included. Labor management included encouragement of trial of labor, labor
stimulation with oxytocin when indicated, epidural analgesia only after entering the
active phase, and continuous monitoring. Demographic, labor and delivery, and neonatal
data were electronically stored and analysis performed using SPSS release 4.1 for
VAX/VMS. Statistical analysis was performed using chi-square and Fisher's exact test
where appropriate. Multiple logistic regression was performed to control for potentially
confounding variables. A previous cesarean had been performed in 713 (11%) gravidas
who met the inclusion criteria. Vaginal delivery was attempted in 588 (82%) and 517
(88%) achieved vaginal birth. Older women (14 versus 1 versus 8%, p = 0.04), of higher parity (63 versus 35 versus 17%, p = 0.0001), requiring preterm delivery (14 versus 8 versus 4%) were more likely to
have an elective repeat cesarean than a successful or failed trial of labor. Pregnancies
requiring oxytocin (90 versus 53%, p = 0.02), receiving epidural analgesia (62 versus 49%, p = 0.05), developing chorio-amnionitis (20 versus 4%, p <0.0001) were more likely to fail a trial of labor. Four uterine ruptures occurred
and only one patient was receiving oxytocin. There were no differences in umbilical
artery blood acidemia among elective repeat cesarean sections and successful or failed
trial of labor. The disciplined approach to labor management used was successful in
achieving a low cesarean rate (12%) in women undergoing a trial of labor without adverse
neonatal outcomes.
Keywords
Trial of labor - cesarean section - labor management dystocia - oxytocin
