TRIAL OF LABOR - A DISCIPLINED APPROACH TO LABOR-MANAGEMENT RESULTINGIN A HIGH-RATE OF VAGINAL DELIVERY

A disciplined approach to labor management has resulted in a low cesar ean rate (9%) in our population. We wondered ii this management scheme was applicable and safe applied to women with previous cesareans. Wom en with a previous cesarean delivering in a 5-year period were include d. Labor management included encouragement of trial of labor, labor st imulation with oxytocin when indicated, epidural analgesia only after entering the active phase, and continuous monitoring. Demographic, lab or and delivery, and neonatal data were electronically stored and anal ysis performed using SPSS release 4.1 for VAX/VMS. Statistical analysi s was performed using chi-square and Fisher's exact test where appropr iate. Multiple logistic regression was performed to control for potent ially confounding variables. A previous cesarean had been performed in 713 (11%) gravidas who met the inclusion criteria. Vaginal delivery w as attempted in 588 (82%) and 517 (88%) achieved vaginal birth. Older women (14 versus 1 versus 8%, p=0.04), of higher parity (63 versus 35 versus 17%, p=0.0001), requiring preterm delivery (14 versus 8 versus 4%) were more likely to have an elective repeat cesarean than a succes sful or failed trial of labor. Pregnancies requiring oxytocin (90 vers us 53%, p=0.02), receiving epidural analgesia (62 versus 49%, p=0.05), developing chorioamnionitis (20 versus 4%, p<0.0001) were more likely to fail a trial of labor. Four uterine ruptures occurred and only one patient was receiving oxytocin. There were no differences in umbilica l artery blood acidemia among elective repeat cesarean sections and su ccessful or failed trial of labor. The disciplined approach to labor m anagement used was successful in achieving a low cesarean rate (12%) i n women undergoing a trial of labor without adverse neonatal outcomes.