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.

Stillbirth at a Nigerian Tertiary Hospital

Background: Despite improvements in antenatal and intrapartum care, stillbirth still remains an important, largely understudied and pregnant problem in obstetrics. Most of the stillbirths occur in the developing world and the majority of stillbirths are preventable. Objective: To determine the stillbirth rate, the identifiable risk factors and sociodemographic factors associated with stillbirths. Materials and Methods: This was a retrospective review of all deliveries conducted at UATH over a five-year period spanning from the January 2012 to December 2016. In this study, stillbirths were considered as foetal death at or after 28 weeks of gestation or a birth weight of 1000 g or more. The folders of cases that met the definition of stillbirth within the study period were retrieved and analyzed for sociodemographic factors, type of stillbirth, fetomaternal determinants of stillbirths and presumptive/identifiable risk factors for the stillbirth. Results: There were a total of 5714 deliveries within the period under review, of which 288 resulted in stillbirths giving an institutional stillbirth rate of 50.4/1000 deliveries. Out of the 288 stillbirths, 136 (47.2%) were fresh stillbirths while 152 (52.8%) were macerated. Macerated stillbirth (152, 52.8%) was slightly predominant, with obstructed labour 94 (32.6%) being responsible for most of the stillbirths. Most of the stillbirths were preterm (183, 63.5%). There were 6 congenitally malformed stillbirth foetuses and no autopsy was carried out on any of the 288 stillborn. However, majority of the parturients who had stillbirth were unemployed (137, 47.6%) and uneducated (110, 38.2%). Conclusion: The stillbirth rate within the study period appears. Complications of labour seem to be the leading risk factor for stillbirth in this study. Low socioeconomic status underscores the need to reduce factors related to social, educational, occupational and healthy inequalities in the developing world.