Comparison between the outcome of trial of labour and elective repeat caesarean section in Kiambu district hospital: a retrospective cohort study

Abstract

Objective: To determine the pregnancy outcomes in patients with one previous Caesarean section scar who underwent trial of labour as compared to those who had elective repeat Caesarean section at Kiambu District Hospital.
Design: A retrospective cohort study.
Setting: Post natal wards of Kiambu District Hospital.
Subjects: Medical records of all mothers with one previous Caesarean section scar who had delivered in Kiambu District Hospital were obtained and the information used to fill questionnaires. Maternal morbidity was assessed primarily based on post-natal hospital stay. Other maternal morbidity measures assessed included occurrence of uterine rupture, maternal death, need for hysterectomy, maternal blood loss, presence of visceral injury (bladder or gut) and post delivery infectious morbidity. In addition, the failure rate of trial of labour was determined. Foetal outcome was assessed based on APGAR score at five minutes, need for admission to the new born unit and the occurrence of early neonatal death.
Results: A total of 142 participants were recruited of which 71 had undergone TOL and 71 had undergone ERCS. Clinical pelvimetry was the most common criteria used for selection of patients for TOL since 100% of all patients in the TOL group were assessed this way as compared to 80.3% in the ERCS group. The success rate of TOL was 50.7% in this study. Successful TOL was associated with less hospital stay since 91.6% stayed for two days or less as compared to ERCS where 84.5% stayed for 3-4days (P<0.001). Similarly, blood loss was less for those who had successful TOL where 97.2% lost less than 500mls as compared to ERCS where 85.9% lost 500mls or more. Maternal outcomes were worse in the 49.7% who failed TOL since only 57.1% of them had a post-natal hospital stay of three to four days as compared to 84.5% in the ERCS group( p=0.029) and 42.9% of the failed TOL group stayed in the hospital for five days or more as compared to only 15.5% in the ERCS group(p=0.002). Foetal outcome was worse in the TOL group since 11.3% had an APGAR score of less than eight at five minutes as compared to only 1.4% in the ERCS group(p=0.016). Similarly, 14.1% of newborns in the TOL group were admitted to the new born unit as compared to only 5.6% in the ERCS group(p=0.091). There were no early neonatal deaths reported in both groups.
Conclusion: Overall success rate for TOL was low necessitating emergency Caesarean section of which the maternal outcomes were worse than in the ERCS group. The foetal outcomes were better in the ERCS group as compared to the TOL group.