Objective To determine the outcome of subsequent labour in primiparous women after a caesarean section for delay in descent in the second stage of labour in cephalic presentations with or without trial of instrumental vaginal delivery.Design Retrospective follow up study. Setting Medical Centre Leeuwarden, The Netherlands. Participants All primiparous parturients who delivered after prior caesarean section during the second stage of labour in the period 1986-1998.Methods Data concerning the outcome of the first subsequent delivery were gathered from delivery notes and patients charts. The group of women was subdivided into those with or without trial of instrumental vaginal delivery during the previous labour.Results Of 132 women, 29 (22%) underwent a planned repeat caesarean section. Of the 103 women who were allowed a trial of labour, 82 (80%) were successful in having a vaginal delivery, and 21 (20%) had a second caesarean section. Of the 74 women with a failed trial of instrumental delivery during the previous labour, 19 had a planned repeat caesarean section and 41 of the remaining 55 (75%) had a successful trial of labour. ConclusionsIn women with a cephalic presentation who had an arrest of descent in the second stage of labour during their first delivery, the chances of vaginal delivery in their next pregnancy are high, even after a failed instrumented vaginal delivery, and a trial of labour can usually be pursued. INTRODUCTIONSeveral studies suggest that for adequately screened women with a prior caesarean section, in a hospital environment, a trial of labour is as safe or even safer than elective repeat caesarean More than 90% of women with a history of previous low transverse section are delivered by repeat caesarean section in the United States3. Successful trial of labour shortens the duration of hospital stay and gives more patient satisfaction. Caesarean delivery at full dilatation is associated with a much reduced chance of successful vaginal birth in a subsequent pregnancy". Delay in descent of the head in labour is associated with cephalo-pelvic disproportion5. Many obstetricians may be unwilling to allow their patients a trial of labour if the caesarean section was preceeded by a delay in descent in the second stage and failed attempt of instrumental delivery by vacuum or forceps. Women with prolonged or dysfunctional labour at the first birth are less likely to attempt a subsequent vaginal delivery, perhaps because of the memory of a painful, long and unsuccessful first labour6. This study was undertaken to determine the outcome of trial of labour in such women. Assessment included whether prior failed trial of instrumental vaginal delivery and birthweight have any predictive value for the chances of a successful trial of labour. METHODSIn our region about 50% of the obstetric population are delivered by general practitioners or midwives; these births take place primarily at home (40%) or in a hospital (10%). Because of risk factors the remaining 50% are delivered in a hospital under the care...

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Objective: To compare the prophylactic efficacy o f 1 g ceftriaxone with 1,5 g cefuroxime + 0.5 g metronidazole for febrile morbid ity and urinary tract infection in patients undergoing vaginal hysterectomy. Study design: A prospective, randomized, comparative, non-blinded study with at least 100 patients on each side. The two-sample /-test was used for testing equality o f two means and the x 2 test was used for pair differences. Results: Single dose cefuroxime + metronidazole and ceftriaxone were equally effective in preventing febrile morbidity postoperatively. Additionally ceftriaxone was more effective in sterilizing pre-operatively existing bacteriuria.

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