Outcome of labour following one previous caesarean section at the University Teaching Hospital, Lusaka

Abstract

The rate of caesarean section has been increasing in the last fifty years. A previous caesarean section has also steadily become a leading indication to perform a caesarean section. With the realization that caesarean section has got its own risks, and the strain on medical costs, the strategy has been to reduce the rate of repeat caesarean section and hence the overall rate of caesarean section. A systematic evaluation of repeat caesarean section has not been performed at the Univesrity Teaching Hospital (UTH) in the last 18 years. In this study, the outcome of trial of labour and factors affecting outcome in previous caesarean section were assessed at UTH in 352 women who presented with one previous caesarean section over a period of 1 year between October 1995 to October 1996. The findings were that 148 out of 352 (42.0%) had a repeat caesarean section, some of which were elective (57 out of 352 -16.2%). Of the 265 who had atrial of labour, 204 (76%) managed a vaginal delivery. Those who had a vaginal delivery after the primary caesarean had a significant higher chance of delivering vaginally (Odds Ratio 3.88 p=0.001). More than half of the women previously delivered by caesarean section for cephalopelvic disproportion managed to deliver vaginally. Uterine rupture occurred in 3 cases, and was not associated with birth weight, or history of previous vaginal delivery.A trial of labour after a previous caesarean is a reasonable and moderately safe option to be followed at UTH.