Trial of Labour

Trial of Labour

Definition: - A test given to a woman with mild or moderate CPD to see if she can deliver her baby with least damage to her self & baby.

The out come of a trial of labour depends on :-

·        The trenght of uterine contraction

·        The stretch of the pelvic joints & ligaments

·        The degree of moulding

·        The attitude of the midwife

Management of a trial of labour

i.                     The trial of labour must be carried out in the hospital where there is a service for caeseraen section at any time.

ii.                     The Pregnancy is allowed to go to term

iii.                     Careful observation are kept. Descent of the head assessed frequently. Strict asepsis is maintained as there is possibility of caeserean section FH and mother’s pulse and B/P is also observed

N.B:- Desent is the most important observation

iv.                     . Keep fasting as patient may need aneshtetic, she may be allowed asips of water.

v.                     Keep her as comforatable and as dry as possible

vi.                     Stay with patient, talk to her have the labour is progressing, and help her to be relaxed. 

The following conditions should be reported to doctor:-

i.            Head still high after 6-8 hrs of good contraction

ii.            Rupture of membrane before full dilation.

iii.            Un satisfactory uterine action

iv.            Change of vertex to face or brow

v.            Fetal distress

vi.            Maternal distress 

A trial of labour has failed when one of the following occurs

i.                     Fetal distress

ii.                     Maternal distress

iii.                     Failure to advance after 6-8hrs of good contraction

When any of the three complications occurs ceaserean section will be done

A trial of scar

When a woman has had a scar of ceaserean section or hysterotomy is given chance to deliver vaginally. This trial is given to see if the scar is strong enough to withstand the labour. Like trial of labour it has to be conducted in hospital.

Conditions in which trial of scar is considered are:

·        spontaneous labour

·        only one cesearean section scar

·        vertex presentation

·        No cephalo pelvic disproportion

·        No doubt about the presentation. 

A failure of trial scar is indicated by

·        Pain and tenderness over the scar

·        Slight vaginal bleeding

·        slight raise in pulse

Vacuum is usually applied in 2^nd stage if there is no sign of rupture.