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  • Title: Pattern of cervical dilatation in previous lower segment caesarean section patients.
    Author: Guleria K, Dhall GI, Dhall K.
    Journal: J Indian Med Assoc; 1997 May; 95(5):131-4. PubMed ID: 9357257.
    Abstract:
    The pattern of cervical dilatation during labour in 100 patients with previous lower segment caesarean section (LSCS) was determined in a prospective partographic study. Eighty-four subjects delivered successfully by vaginal route. The mean initial dilatation rate (IDR) and average dilatation rate (ADR) were 0.884 cm/hour and 1.255 cm/hour respectively. The mean IDR and ADR of the patients who delivered vaginally were 0.96 cm/hour and 1.41 cm/hour respectively, while of those who required repeat LSCS mean IDR was 0.44 cm/hour and mean ADR was 0.42 cm/hour. Hence ADR in cases who required repeat LSCS was significantly slower as compared to those who delivered vaginally (p < 0.01). Most (87.5%) of the cases who required repeat LSCS crossed the alert line as compared to 34.5% of patients who delivered vaginally. The mean admission delivery interval (ADI) was 9.45 +/- 4.29 hours in patients with no previous vaginal delivery and 8.02 +/- 4.83 hours in patients with previous vaginal delivery. The mean durations of 1st and 2nd stages of labour were 11.8 +/- 5.35 hours and 29.4 +/- 27.3 minutes respectively. It is concluded that partographic evaluation is an important aspect in management of labour of such patients. 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.
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