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Oxytocin use after previous cesarean: why a higher rate of failed labor trial?
When used for patients undergoing trial of labor after previous cesarean, oxytocin is associated with an increased failure rate. Previous reports have not studied why this occurs. From October 1984 to April 1986, 237 patients with previous cesareans underwent a trial of labor. The delivery outcomes of 73 women who received oxytocin were compared with those of the 164 who did not. Rates were similar for uterine scar dehiscence, uterine rupture, operative vaginal delivery, blood transfusions, endometritis, and low Apgar scores. Successful trial of labor occurred in 68% in the oxytocin group, compared with 89% in the no-oxytocin group. Failed trial of labor was significantly more frequent in patients who received oxytocin for induction of labor than in those who did not. When subjects who received oxytocin were divided into induction (N = 47) and augmentation (N = 26) groups, successful trial of labor occurred in 58% of the former group versus 88% of the latter group. Other characteristics of the augmentation group were spontaneous labor, greater cervical dilation and effacement at initiation of oxytocin, shorter duration of infusion, and lower oxytocin infusion rates. For patients who have had previous cesareans and who desire trial of labor, oxytocin by controlled infusion is safe. Successful trial of labor may be enhanced by awaiting spontaneous labor or inducing with a favorable cervix.
[The prospective study of trial labor following previous cesarean section].
OBJECTIVE: To investigate the trial of labor following previous cesarean section. METHODS: Three hundred and sixty one cases of pregnant women with history of previous low segment transverse cesarean section were prospectively studied on mode of delivery. 158 cases delivered by elective repeat cesarean section. 203 cases were allowed a trial of labor. RESULTS: 183 out of 203 patients had successful vaginal deliveries. One patient with uterine scar partly ruptured was noted on uterine exploration after delivery. There was no maternal death. The rate of spontaneous vaginal delivery was 79.2%. The rate of vacuum extractor and low forceps deliveries was 20.8%. The 1 minute Apgar score of 170 newborns was > or = 8. Neonatal asphyxia was found in 13 newborns and there was one neonatal death due to congenital abnormality. CONCLUSIONS: Carefully selecting the indication of trial labor and monitoring the labor course are very important for increasing successful vaginal delivery rate and reducing repeat cesarean section.
["Labor trial" for breach presentation].
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Trial labor following previous cesarean section.
Elective repeat cesarean section continues to remain the standard of care in the United States. This paper is a study of 242 patients with previous cesarean section who requested and were allowed a trial of labor. One hundred sixty-six (69%) achieved successful vaginal delivery with no maternal or fetal mortality or significant morbidity. Review of the English literature indicates similar results in other independent studies. Continued accumulation of cases showing the efficacy of post-cesarean section trial of labor should encourage a reassessment of the continuing practice of elective repeat cesarean section.
[Transitional anomalies of the lumbosacral region as prognostic element in trial labor in certain pelvic limitations].
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An analysis of 121 trial labors following a previous cesarean section.
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[Trial labor or cesarean section?].
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Risk to the fetus in prolonged and trial labor.
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[Induced labor and a trial of labor].
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Previous cesarean section: the risks and benefits of oxytocin usage in a trial of labor.
Permitting a trial of labor in patients with a previous cesarean birth is rapidly becoming an accepted alternative to routine elective repeat cesarean section. As interest in this approach has grown and the risks associated with a trial of labor have been better defined, the use of oxytocin in these patients emerges as a pertinent issue. Our retrospective experience of oxytocin use in patients undergoing a trial of labor suggested no increased maternal or fetal risk compared to patients who did not receive oxytocin. On the basis of our prior experience, we set out to investigate prospectively the role of oxytocin in 732 patients with prior cesarean section who underwent a trial of labor. During the study period, 289 (40%) patients received oxytocin for either induction (32, 11%) or augmentation (257, 89%) of labor and 443 patients did not receive oxytocin. Successful vaginal delivery was achieved in 200 patients (69%) as opposed to 395 (89%) of the patients who did not receive oxytocin. The incidences of dehiscence in the oxytocin and no oxytocin groups were 3% and 2%, respectively. Further analysis of vaginal and cesarean delivery complications for the two groups were contrasted and no significant differences were found with respect to the incidence of hemorrhage, uterine atony, hysterectomy, or the requirement of transfusions. Neonatal outcome was also comparable for both groups. On the basis of our prospective experience, it appears that the use of oxytocin, when carefully monitored, is a safe and reasonable consideration in the patient undergoing a trial of labor.
Trial of labor in women with transverse vaginal septa.
BACKGROUND: Transverse vaginal septa are rare anomalies that may be first diagnosed during pregnancy. Management options including elective cesarean delivery, incision before labor, and a trial of labor have been proposed. CASES: Two patients with transverse vaginal septa were allowed a trial of labor. The septa were incised in active labor, resulting in vaginal delivery with no related complications. CONCLUSION: Allowing a trial of labor despite a transverse vaginal septum is a reasonable management option in selected cases.
[Trial of labor in moderate pelvic dystocia at Dakar University Teaching Hospital].
OBJECTIVE: To study frequency of moderate pelvic dystocia, to evaluate the diagnosis value of clinical pelvic evaluation and prognosis of trial labor with only clinical monitoring. MATERIAL AND METHOD: This is a prospective, exposed and non-exposed study concerning 296 women selected among deliveries presenting moderate pelvic dystocia recorded at Dakar University Teaching Hospital from February 1st 2001 to July 31 2002. Trial labor was undertaken in 148 patients; the control group was chosen among women who underwent prophylactic caesarean section and had no other risk factors of maternal and perinatal complications. Pearson's chi-square test was used or statistic analysis with p value 5% and test of Kappa. RESULTS: Moderate pelvic dystocia was observed 5.3 per 100 deliveries. The most common epidemiological profile was primipara, young age (mean 24 years), height 161 cm (mean), 38-week pregnancy (mean). Clinical evaluation had good diagnosis value comparable with the radiological pelvimetry. Trial labor was undertaken in 148 women, 109 trials (73.6%) were successful; vaginal delivery rate was 27% in women with moderate pelvic dystocia. There were no maternal deaths, maternal morbidity was 4% in trial labor patients and 2.7% in prophylactic caesarean section patents (mainly infection). Post-natal mortality was 7.4% after trial of labour versus 4.1% of newborn child after prophylactic caesarean. CONCLUSION: These results confirm that trial of labor on moderate pelvic dystocia should be the rule whenever possible, even when only clinical monitoring is available.
Delivery through the maternal bladder during trial of labor.
BACKGROUND: The safety of trial of labor after cesarean has been documented by numerous studies. Large series have demonstrated that in a properly chosen setting, 75% of women can achieve vaginal delivery without undue risk to the mother or fetus. In a small percentage of cases, trial of labor deviates from the expected outcome. CASES: Two infants were delivered through the maternal bladder, one after uterine dehiscence and the other after vaginal rupture at trial of labor. CONCLUSION: Standard and unique complications are reported with trial of labor. Because these complications occur infrequently, they should not discourage an attempt at vaginal delivery after cesarean.