Trial of scar with induction/oxytocin in delivery following prior section.

During the ten year study period, April 1972 to March 1982, there were 1,498 patients, with one or more prior caesarean section delivered at the Regional Hospital, University College, Galway. Trial of scar (TOS) was undertaken in 844 (56.34%) patients and the remaining 654 (43.66%) had a repeat elective caesarean section. There were 546 (64.69%) TOS patients who had some form of induction/augmentation and in 269 (49.26%) oxytocin was used, singularly and in combination with other induction methods and successful vaginal delivery was attained in 222 (82.52%) patients. There was no increased incidence of true rupture (TR) or bloodless dehiscence (BD) associated with the use of induction/augmentation or oxytocin in this series. There was a 50% perinatal mortality associated with TR, but there was no maternal death in TOS patients, with or without a successful trial. An incidence of TR of 1:169 patients is no justification for the "once a section, always a section" idiology, widely practiced in North America today.