Kalisa R, et al. – At a district hospital in rural Rwanda, they performed this study to compared the maternal and perinatal outcomes between the trial of labor (ToL) and elective repeat caesarean section (ERCS). The current study showed that a considerable proportion of women delivering at a rural Rwandan hospital had scarred uteri. Severe acute maternal morbidity was higher in the ToL group, perinatal mortality did not differ. ToL took place under suboptimal conditions: access for women with scarred uteri into a facility with 24–h surgery ought to be guaranteed to increase the safety of ToL.

Methods

• For this research, they conducted a retrospective cohort study.
• In this review, they selected women’s records with the history of one prior CS who delivered at Ruhengeri district hospital in Rwanda between June 2013 and December 2014.

Results

• Total 4131 women were included in this study.
• In this study, 435 (11%) women had scarred uteri out of these 4131 women who came for delivery.
• ToL, which often started at home or at health centers without appropriate counseling, occurred in 297/435 women (68.3%), while 138 women (31.7%) delivered by ERCS.
• ToL was effective in 134/297 (45.1%) women.
• No maternal deaths were observed.
• 28 out of all 435 women with a scarred uterus (6.4%) sustained severe acute maternal morbidity (puerperal sepsis, postpartum hemorrhage, uterine rupture), which was higher in women with ToL (n = 23, 7.7%) compared with women who had an ERCS (n = 5, 3.6%): adjusted odds ration (aOR) 1.4 (95% CI 1.2–5.4).
• There was no difference in neonatal admissions between women who underwent ToL (n = 64/297; 21.5%) and those who delivered by ERCS (n = 35/138; 25.4%: aOR 0.8; CI 0.5–1.6).
• The majority of admissions were due to perinatal asphyxia that occurred more often in infants whose mothers underwent ToL (n = 40, 13.4%) compared to those who delivered by ERCS (n = 15, 10.9%: aOR 1.9; CI 1.6–3.6).
• Perinatal mortality was similar among infants whose mothers had ToL (n = 8; 27/1000 ToLs) and infants whose mothers underwent ERCS (n = 4; 29/1000 ERCSs).