Vaginal delivery after previous caesarean section for failure of second stage of labour

Abstract

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...

Vaginal Birth after Cesarean and Trial of Labor after Cesarean: What should we be Recommending Relative to Maternal Risk: Benefit?

“…There are additional factors that increase the chance of a successful VBAC. If the first CD was a result of a nonrecurring indication (i.e., fetal distress, abruption, breech, among others), the likelihood of a successful VBAC is increased as compared with a recurring indication such as labor disorders or CPD [29,[60][61][62][63][64]. The probability of VBAC has been reported to be approximately 75% when the CD was performed for nonrecurring indications [5,59,[65][66][67].…”

Uterine Contractions' Pattern in Active Phase of Labor as a Predictor of Failure to Progress

“…This problem is developed when a large size of fetal head or unsuitable position between the fetus’ head and mother’s pelvis diameter as well as mismatch between two these components exists, which is named cephalo-pelvic disproportion (CPD) in the field of obstetrics ( Gao et al, 2013 ; Kovavisarach & Buddeewong, 2012 ). CPD inhibits progress of labor which in turn increases the chance of maternal and fetal complications ( Hodnett, Gates, Hofmeyr, Sakala, & Weston, 2011 ; Jongen, Halfwerk, & Brouwer, 1998 ). Some of these complications include: the risk of chorioamnionitis, birth trauma, postpartum hemorrhage and infection as well, which in the cases of forceps or vacuum delivery, these complications could be increase.…”

Vaginal delivery after previous caesarean section for failure of second stage of labour

“…I read with interest the paper by Jongen et al (Vol 105, October 1998) 1 that addresses a difficult obstetric problem. They conclude that for women during their first delivery, in whom the fetus had a cephalic presentation with an arrest of descent in the second stage of labour, the chances of a vaginal delivery in their next pregnancy are high.…”

“…Although there was an 80% vaginal delivery rate reported, one has to recognise that overall only 40/103 (39%) of the women achieved a spontaneous vaginal delivery, or to state the converse, 63/103 women in this selected group required a Caesarean section or instrumental vaginal delivery. 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 long, painful and unsuccessful first labou 1 . If aware of the fact that there is a less than 50% chance of a successful spontaneous vaginal delivery, I would suggest that many women would choose to have an elective caesarean section and therefore it is inappropriate to conclude that a trial of labour can usually be undertaken.…”