Objectives

1. IS SPONTANEOUS ONSET OF LABOUR MORE SUCCESSFUL THAN INDUCED LABOUR AMONG PATIENT WITH ONE PREVIOUS SCAR? A RETROSPECTIVE STUDY IN AMPANG HOSPITAL, MALAYSIA. OPTIONALLOGO HERE OPTIONALLOGO HERE 1S KHALID, 1M MASRI, 1SHAMSIR ARIS, 2M GANESALINGAM 1Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia. 2Department of Obstetrics Gynaecology, Hospital Ampang, Malaysia. Background Results Results Conclusions From a total of 6832 deliveries, 277 patients with one previous scar opted for VBAC as their mode of delivery. 25 (9.03%) of patients had to have ELLSCS for obstetrics indications. While 208 (75.09%) of patients had spontaneous onset of labour. 44 (21.15%) had induction of labour for various obstetrics indications (Figure 1). 15 (34.09%) had one tablet of 3mg prostin, 27 (61.36%) had two prostin tablets and 2 (4.54%) had three prostin tablets. Interestingly to note that eight patients who had one prostin tablet followed by six patients who had 2 prostin tablets and both of patients who had 3 prostin tablets had successful vaginal birth. 16 (36.36%) patients who were induced had successful vaginal delivery compared to 132 (63.46%) in patients with spontaneous onset of labour. 5 (11.36%) and 11 (5.29%) had instrumental vaginal delivery respectively. While 23 (52.27%) who were induced had EMLSCS, of which 14(31.82%) cases were due to failed induction of labour. 65 (31.25%) patients with spontaneous onset of labour had EMLSCS (Figure 2). There was no documented scar dehiscence or uterine rupture in all 44 patients who were induced. The success rate for a planned Vaginal Birth After Caesarean section (VBAC) after a single previous section has been documented to be 72- 76% (1). Previous vaginal delivery is s single best predictor for successful VBAC with a success rate of 87-90% (2). Risk factor for unsuccessful VBAC include induced labour, no previous vaginal birth and BMI of more than 30 (3). Patients with one previous scar should be made aware that VBAC will be more successful if labour was a spontaneous onset. If labour need to be induced in patient with one previous scar, it should be noted that the success rate is around 36%. From our data it can be concluded that, induction of labour with prostin tablets in patient with one caesarean scar is relatively a safe procedure. Figure 1 Structure of the study. Objectives To compare the outcome in patients with one previous scar between those who had a spontaneous onset of labour and those who had induction of labour (IOL) in Ampang Hospital, Malaysia in year 2010. Figure 2 Mode of deliveries among patients with one previous scar. References Methods Landon MB, Hauth JC, Leveno KJ, Spong CY, Leindecker S,Varner MW, et al. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. N Engl J Med 2004;351:2581–9. Landon MB, Leindecker S, Spong CY, Hauth JC, Bloom S, Varner MW, et al. The MFMU Cesarean Registry: factors affecting the success of trial of labor after previous cesarean delivery. Am J Obstet Gynecol 2005;193:1016–23. Hibbard JU, Gilbert S, Landon MB, Hauth JC, Leveno KJ, Spong CY, et al. Trial of labor or repeat cesarean delivery in women with morbid obesity and previous cesarean delivery. Obstet Gynecol 2006;108:125–33. A retrospective study was conducted in Hospital Ampang from 1st January until 31st December 2010. Patients with one previous scar and had no previous history of spontaneous vaginal delivery were identified. The onset of labour whether it was a spontaneous or induced labour as well as the mode of delivery were then documented.