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Sir,

We thank Chattopadhyay et al. (Vol 101, June 1994) for readdressing this much ignored aspect of our practice. We agree with the authors that trial of labour after two previous caesarean sections could be a reasonable option with careful patient selection. However, some of their criteria for selecting the patients seem too strict or difficult to understand.

The use of X-ray pelvimetry would appear unnecessary in the light of recent clinical trials (Fraser 1992) and, if used, a true conjugate of 105 cm would be considered narrow by many obstetricians in the UK. We could not understand why women with cervical dilatation above 3 cm were excluded; surely this could be evidence of spontaneous labour with greater likelihood of a successful outcome compared with women who had their labours induced. The low vaginal delivery rate (54 %) following one previous caesarean section was also surprising and there was no appropriate explanation for this.

We believe that had different selection criteria, based on published scientific data been used, more women would have been eligible for recruitment and a likely higher spontaneous vaginal delivery achieved.

References

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  2. References
  • Chattopadhyay S. K., Sherbeeni M. M., Anokute C. C. (1994) Br J Obstet Gynaecol 101, 498500.
  • Fraser W. D. (1994) X-ray pelvimetry in cephalic presentations. In Pregnancy and Childbirth Module (M. W.Enkin, M. J. N. C.Keirse, M. J.Renfrew, & J. P.Neilson, eds), Cochrane Database of Systematic Reviews: Review No. 03229, 28 July 1992. Published through Cochrane Updates on Disk, Update Software, Oxford , Disk issue.