Predictors of vaginal delivery in patients with a previous cesarean section, who require oxytocin

Abstract

Prospective analysis of 98 consecutive patients at term pregnancy with one previous cesarean section, who received oxytocin during a trial of labor (34 inductions, 64 augmentations), was undertaken to identify specific factors associated with successful vaginal delivery. The overall vaginal delivery rate was 59.2%. Comparing route of delivery in the induction and augmentation groups separately revealed no significant differences in maternal height, weight, or parity, duration of membrane rupture, length of oxytocin treatment or maximum dose, cervical examination on admission or before oxytocin treatment, or use of conduction anesthesia. A previous vaginal delivery favored repeat vaginal delivery in patients with augmentation while a nonrecurrent indication was significantly associated with vaginal delivery in all patients. After the beginning of oxytocin augmentation, the cervical dilatation rate was 1.82 cm/hr in patients delivered vaginally, compared with 0.18 cm/hr in those requiring cesarean section (p < 0.001). Any cervical dilatation during the first 2 hours of augmentation was associated with more frequent vaginal delivery: 24 of 40 vaginal deliveries (60%) versus six of 24 cesarean sections (25%, p < 0.01). Discriminant analysis correctly identified route of delivery in 85.3% of those with induction and 87.5% of patients with augmentation. During a trial of labor, oxytocin induction or augmentation is effective in a majority of patients. Furthermore, an early response during augmentation is of predictive value when such patients are being managed.