1. No relation was found between either gestational age or birth weight and the incidence of emergency caesarean section. In analysing the possible predictive factors for delivery by emergency caesarean section particular attention was paid to the cervical dilatation at the time of the previous caesarean section (table IV) and whether the patient had previously achieved a vaginal delivery (table V). Patients who had not attained a cervical dilatation of4cm at the time ofthe previous caesarean section were less likely to achieve a vaginal delivery than any other group, even those who had previously had an elective caesarean section (p=0-021). Furthermore, patients who had previously delivered vaginally either before or after the original caesarean section had a significantly lower rate of emergency section than those who had not had a previous vaginal delivery (p<0-001)
2. Only one intrapartum fetal death occurred among the 1781 women who were allowed into labour. This death was associated with rupture of the scar in a 38 year old gravida 7 who had had two previous vaginal deliveries after caesarean section for placenta praevia; she had started labour spontaneously and had not been given oxytocin or an epidural anaesthetic. One ofthe seven babies who survived uterine scar rupture developed severe cerebral palsy and
3. It has been reported that patients with a history of vaginal delivery after caesarean section are more likely to deliver vaginally again.'7 1920 In our study patients who had delivered vaginally either before or after the initial caesarean section had a lower incidence of emergency caesarean section than those who had not (p=0001). The incidence of repeat caesarean section was significantly increased (p=0021) if the initial caesarean section had been performed in labour before the cervix was 4 cm dilated. This was probably due to recurrent cervical dystocia, and it is difficult to see how the repeat caesarean section rate could have been reduced among this group of subjects
4. The incidence of intrapartum fetal death (one in 1781) recorded among this potentially high risk group of patients was low and no different from that recorded among other patients in the hospital during the study period
5. Vaginal delivery in patients with prior cesarean section;Lavin, J.P.; Stephens, R.J.; Miodovnik, M.; Barden, T.P.;Obstet Gynecol,1982