Trial of Labour after Caesarean Section: A 5-Year Review

Background: Trial of labour after Caesarean section (TOLAC) refers to an attempt at vaginal delivery after a previous caesarean section. Outcome is influenced by a number of factors which are important in patient’s selection. Objectives: The aim of this study was to find out the incidence and feto-maternal outcome of the practice of Trial of labour after Caesarean section. Methodology: This is a retrospective study of cases of vaginal birth after Caesarean section Data were retrieved from the case notes of patients who attempted vaginal birth after Caesarean section from January 1, 2013 to December 31, 2017, a period of five years. Result: There were 10,669 deliveries, 3179 of which were through Caesarean section. This gave a Caesarean section rate of 29.8%. A total of 217 patients attempted vaginal birth after Caesarean section and 83 ended up as repeat Caesarean section (38.2%) while 138 (61.8%) had successful vaginal birth after Caesarean section. Patients with previous vaginal delivery, age range 25 - 29 years and interdelivery interval of greater than or equal to 2 years were more successful at achieving vaginal birth after Caesarean section. The leading indications for the repeat Caesarean section include cephalopelvic disproportion (45.8%), poor progress of labour (19.3%) and hypertensive disorders of pregnancy (8.4%). Conclusion: Vaginal birth after Caesarean section was successful in most of the parturients that attempted it in this study especially in patients within the age range of 25 - 29 years, those that have had previous vaginal delivery and with interdelivery interval of greater than or equal to 2 years.

Effect of Hyoscine Butyl Bromide on the Course of Labour

Background: Hyoscine butyl bromide (Buscopan) is being used as an agent for reducing the duration of labour. There are however conflicting results on the effect of this agent on cervical dilation. Materials and Methods: This was an open label clinical trial of one hundred and thirty two (132) pregnant women in labour. Women were grouped to receive either 20 mg of hyoscine butyl bromide intramuscularly at the onset of active phase labour or placebo “Normal saline”. The main outcome measure was to compare the duration of first stage labour in the study and control groups as well as feto-maternal outcomes. Relevant data were collected using a proforma. The data were analysed using Statistical Package for Social Sciences (SPSS) version 20. Results: A total of 132 were randomised and 123 yielded for analysis. Of these 59 received hyoscine butyl bromide and 64 received placebo. There was no significant difference in the mean duration of active labour to second stage between the drug and placebo arms (312.5 versus 305.3 minutes, respectively, P = 0.788). The feto-maternal outcomes were similar between both arms. Conclusion: Hyoscine butyl bromide does not shorten the duration of labour in spontaneous labour. It also does not change feto-maternal outcomes.