Pattern of cervical dilatation in previous lower segment caesarean section patients
Guleria, K.; Dhall, G.I.; Dhall, K.
Journal of the Indian Medical Association 95(5): 131-134
1997
ISSN/ISBN: 0019-5847 PMID: 9357257 Document Number: 269710
The feasibility of vaginal delivery after a previous lower-segment cesarean section (LSCS) delivery was investigated in a prospective partographic study of 100 women with a LSCS history. Cervical dilatation, effacement, and fetal head descent were evaluated every 2-4 hours by vaginal examination and the results were recorded on the labor partogram. 84 of these women were able to deliver vaginally; the remaining 16 required repeat LSCS. The main indications for repeat LSCS were fetal distress (6 cases) and right occipitoposterior presentation (4 cases). The mean duration of the first stage of labor was significantly prolonged in women with one previous LSCS only compared with those with intercurrent vaginal deliveries. The mean initial and average dilatation rates were 0.96 and 1.41 cm/hour, respectively, among women who delivered vaginally and 0.44 and 0.42 cm/hour, respectively, in those who had a repeat LSCS. All women with an initial dilatation rate of 1 cm or more per hour and 96% of those with an average dilatation rate of 0.5 cm or more per hour delivered vaginally. 87.5% of women who required LSCS crossed the partogram's alert line compared with 34.5% of those who delivered vaginally. These findings confirm that vaginal delivery after cesarean section is both safe and successful in properly selected women. Partographic evaluation is an important tool in the management of the labor and delivery of previous LSCS patients.