Feto - Maternal Outcome ; Trial of Labour a Study at Tertiary Care Hospital

.. Background: Trial of labour is a clinical test to assess the adequacy of pelvis and ability of fetus and mother to withstand labour. If progressive changes in dilation and station do not occur, a cesarean delivery is performed. Objective: Feto-maternal outcome after trial of labour in women with gestational age b/w 37 to 42 weeks. Study Design: Cross sectional study. Setting: Department of Obs/ Gyn unit-I Liaquat University Hospital Hyderabad. Duration of Study: One year from 01-02-2009 to 31-01-2010. Subjects and Methods: 100 pregnant women, with gestational age between 37-42 weeks, who underwent trial of labour at labour ward, Obs/Gyn Unit-1 Liaquat University Hospital, after fulfilling the inclusion criteria were included in the study. Detailed history and examination including abdominal and pelvic examination as well as Ultrasound for fetal well being was performed. Fetal monitoring was done by auscultation and CTG. Partogram was maintained to observe the progress of labour. Those who progressed with trial either delivered normally or with the help of instruments and those who did not progress were delivered by C-section. After delivery, mothers were watched for any postpartum complication and condition of neonates was assessed by APGAR score. Results: Out of 100 women included in this study 58% delivered vaginally, 31 % delivered by cesarean section and 11 % had instrumental deliveries. Labour was induced in 34%, augmented in 34% and 32% had spontaneous labour. 77.0% babies had apgar score > 5(7.1±0.72), 16% < 5(3.68±2.18) and 6% were still birth. 81% mothers had no complication during or after delivery, whereas 19 developed complications and these were 12 Genital tract traumas, 5 postpartum haemorrhage, one uterine rupture and one retained placenta. There was no statistically significant difference (P=0.42) when mode of delivery was compared with the trial of labour. However augmentation of labour was associated with increased rate of maternal complications when maternal outcome was compared with the type of labour (P=0.03). Conclusions: Trial of labour in carefully selected women with high probability to deliver their babies vaginally decreases the rate of LSCS, thereby reducing the maternal morbidity and mortality associated with it. However augmentation of labour is associated with increased rate of maternal complications as compared to spontaneous or induced labour.