1. TEMPLATE DESIGN © 2008 www.PosterPresentations.com INDCUTION OF LABOUR WITH FOLEYS CATETHER IN WOMEN WITH PREVIOUS ONE CAESAREAN SECTION NURYUZILIANA D, SOFIAH S, VIJAENDREH S UNIVERISTY OF MALAYA, KUALA LUMPUR ; HOSPITAL BESAR MELAKA Objectives ResultsConclusions References Content goDodd JM, Crowther CA, Hiller JE, Haslam RR et al. Birth after Caesarean study – planned vaginal birth or planned elective repeat Caesarean for women at term with a single previous Caesarean birth : protocol for a patient preference study and randomized trial. BMC Pregnancy Childbirth 2007; 7:17 Landon MB, Hauth JC, Leveno KJ et al for the National Institute of Child Health and Human Development Maternal Fetal Medicine Units Network: Maternal and Perinatal outcomes associated with trial of labor after prior caesarean delivery. N Engl J Med 2004; 351: 2581-2589 Royal College of Obstetricians and Gynaecologists. Birth after previous Caesarean birth. Green-top guideline No 45. London: RCOG, February 2007. American College of Obstetricians and Gynaecologists Committee on Obstetric Practise. ACOG Practise Bulletin No 54: Vaginal birth after caesarean. Obstet Gynaecol 2004; 104:203 – 12 Society of Obstetricians and Gynaecologists of Canada. SOGC Clinical Practise Guidelines. Guidelines for vaginal birth after previous caesarean birth. Number 155 (Replaces guideline Number 147), February 2005. Int J Gynaecol Obstet 2005; 89:319-31 Wen SW, Rusen ID, Walker M, Liston R et al. Comparison of maternal mortality and morbidity between trial of labor and elective caesarean section among women with previous caesarean delivery. Am J Obstet Gynaecol 2004; 191: 1263-9 Smith GC, Pell JP, Cameron AD, Dobbie R. Risk of perinatal death associated with labor after previous caesarean delivery in uncomplicated term pregnancies. JAMA 2002; 287: 2684-90 Taj G, Sohail N, Cheema SZ et al. Review of study of vaginal birth after caesarean section. Annals 2008; 14: 13-16 Vardhan S, Behera RC, Sandh et al Vaginal birth after caesarean delivery. J Obstet Gynaecol India 2006; 56: 320-323 Bhat BPR, Savant R, Kamath A. Outcome of a Post Caesarean pregnancy in a tertiary centre of a developing country. Journal of clinical and Diagnostic Research February 2010; 4: 2005-2009 George G, Rajesh V. Vaginal birth after Caesarean section: a practical evidence-based approach. Obstetrics gynaecology and reproductive medicine 2009; 19:7 Miller AD, Diaz FG, Paul RH. Vaginal birth after caesarean: a 10 year experience. Obstet Gynaecol 1994; 84: 255-8 Tan PC, Subramaniam RN, Omar SZ. Labor and perinatal outcome in women at term with one previous lower segment caesarean: A review of 1000 consecutive cases. Aust NZJ Obstet Gynaecol 2007; 47 (1): 31-6 Ola ER, Imosemi OD, Abudu OO. Vaginal birth after one previous caesarean section – evaluation of predictive factors. Afr J Med Sci 2001; 30 (1-2): 61-6 Martin JN, Perry KG, Robert WE, Megdrech E. The case for trial of labour in the patients with prior low segment vertical caesarean section. Am J Obstet Gynecol 1997; 177: 144- 148 Shah JM, Mehta MN, Gokhale AV. Vaginal birth after caesarean delivery. Obs & Gynae. Today 2007;12 (6): 280-281 Lai SF, Sidek S. Delivery after a lower segment caesarean section. Singapore Med J. Feb 1993; 34 (1): 62-6 INTRODUCTION The incidence of caesarean section has increased markedly for the past 20 years it accounts for 21.3% of all births in United Kingdom, 23% in Northern Ireland, 23.3% in Australia and 26% in United State.. Several steps were taken in trying to reduce it. In Malaysia similar trend is seen with current average Caesarean section rate in government hospital ranges from 20-30%, compared with about 15% in year 2006. Induction of labour (IOL) in women attempting trial of labour after a previous caesarean delivery (TOLAC) is a major concern because of the possibility increased risk of uterine rupture. Mechanical induction with Foley’s catheter had been shown less risk of uterine rupture and maternal morbidity with good success rate of vaginal delivery. OBJECTIVE To assess the outcome of induction of labour (IOL)r in women with one previous LSCS with Foleys catheter. These included looking at the rate of successful vaginal deliver and safety of the procedure. Our secondary outcome is to evaluate the predictive variables for successful IOL with Foleys catheter. The option of IOL in women with previous caesarean section with Foleys catheter can be consider in future in obstetric practise. In conclusion, induction of labour with the use of an intra-cervical Foleys’ catheter in women with previous caesarean section increases the success rate of vaginal delivery and it has less complication of uterine scar ruptured. Methods A prospective observational study conducted in Hospital Besar Melaka from 1st January 2010 till 31st December 2010. Patients with singeleton, term pregnancy and uncomplicated previous one caesarean section were recruited in this study. Our exclusion criteria were patients refused TOLAC, multiple pregnancy, PROM, 2 or more previous caesarean section, contraindication to TOLAC and previous history of uterine rupture. Bishops score was documented. Foley catheter size 16F was inserted into the intra-cervical os. It was then inflated with 40cc of water and left in situ for 24 hours. A 20 minutes cardiotocography (CTG) was recorded before and after the procedure. Contractions were reviewed and a repeat vaginal examination was done after 24 hours or earlier if the Foleys catheter spontaneously drop. Artificial rupture of membrane (ARM) was done for favourable cervix and labour progress was review after 4 hours. Oxytocin will only be commenced when the progress of labour was slow. In this study, failed IOL was defined as women who failed to progress to active phase of labour (unable to proceed with ARM) or had slow progress of labour after ARM and proceeded with emergency LSCS. A total of 104 patients were recruited in this study. 64 women (61.5%) had history of successful TOLAC and 40 women (38.5%) had no history of TOLAC. The indications for IOL were prolonged pregnancy/ post-datism with 49 cases (47.1%), Gestational diabetes with 35 cases (33.7%), 12 cases for hypertensive disorder (11.5%) and 8 cases for other indication such as IUGR, oligohydramnions and reduced foetal movements. 66 women had successful vaginal deliveries and the remaining 38 women underwent emergency Caesarean section, showing a success rate of 63.5%.During this study, we observed 2 women had scar dehiscence and one with uterine rupture. All 3 women were in the active phase of labour. It was found that favorable Bishops score or successful TOLAC is not positive predictive factor for successful IOL. However, we observed that multipara women were more likely to have successful IOL with Foleys (p value <0.001)

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