1. Trial of labour cont.
Is a conduction of spontaneouslabour in a mild or
moderate cephalo-pelvic disproportion.
" It is performed under close observation by the
obstetrician.
Indications
"Mild to moderate cephalo - pelvic disproportion.
Women who had cacsarean section for condition
such as cord prolapse, placenta previa etc.
2. Trial of labour cont.
Contraindications.
Elderly primigravida.
Gross pelvic contractures or deformity.
"In the presence of malposition or malpresentation.
" In the presernce of pre-eclampsia, diabetes
mellitus, severe hypertension, cardiacdiseases.
3. Trial of labour cont.
Pre-requisites for trial of labour.
Adequate Supervision including
electronic fetal monitoring.
continuous
" All the facilities for assisted birth are readily
available. Progress of labour is suflicient, observed
both in the descent of presenting part and by the
dilatation of the cervix.
The woman and her partner are fully informed
aboutthe risks and benefits.
4. Trial of labour cont.
Management.
" Insert intravenous line with Ringer's Lactate
solution at 120ml/hour
Monitor fetal heart and contractions with a
cardiotocography(CTG).
"Plot the progress of labour on the partogram and
intervine timeously.
5. Trialof labour cont.
Observe carefully for signs of imminent uterine
rupture such as sudden cessation on contractions
and abdominal pain between contractions.
Complications on the woman.
Uterine rupture.
" Infection.
Bleeding with needed transfusion.
6. Trial of labour cont.
Complications on the fetus.
Hypoxic ischemic encephalopathy.
" Fetal compromise.
Fetal death
7. Trial of labour cont.
Trial of scar
" When a woman had scar of caesarean section or
Hysterotomy is given a chance to deliver vaginally.
Thetrial is given to see if the scar is strong enough
to withstand the labour.
"The labour is conducted at the hospital.
8. Trial of labour cont.
Signs of failure of trial of scar.
" Pain and tenderness over the scar.
Slight vaginal bleeding.
Slightelevated pulse.
Trial of labour after caesarean section (TOLAC) is an
attempt or planned vaginal birth after caesarean
section.
