Trial of Labour

Trial of labour is a test of labour conducted where there is a minor or moderate degree of Cephalopelvic
Disproportion (CPD) in which it is difficult to decide whether delivery per vagina is possible.

Factors influencing good prognosis

There are several factors influencing good prognosis. These are:
 Strength of the uterine contractions
 Flexion of the head
 Degree of moulding of the foetal head, that is, reduced engaging diameters
 The giving of pelvic joints. In pregnancy, the joints of the pelvis are relaxed and separate by half to
one centimetre
 Maternal courage

Factors influencing poor prognosis

The factors influencing poor prognosis are:
 Early rupture of membrane which may be accompanied by prolapsed cord
 Poor moulding of the head
 Maternal or foetal distress which will necessitate intervention on trial of vaginal delivery
Remember: Do not hesitate to terminate the trial of labour when there is foetal or maternal distress.

Contraindications for trial of labour

Compare the following list of contraindications for trial of labour with those you learnt in normal labour:
 Grossly contracted pelvis
 Medical or obstetrical complications
 Malpresentations, for example, breech
 Elderly primigravida
 Cases where trial of labour failed before
 Cases of two previous caesarean sections

Remember: Your encouragement and friendly attitude will boost the mother’s morale.
Management of Trial of Labour
Explain the situation to the mother and prepare her for possible operative intervention. Assess patient
carefully on admission to ascertain the following:
 Whether the mother is in established labour
 Presentation of foetus
 Check for flexion of the head
 State of foetal heart, that is, rate, rhythm and volume
 General condition of mother physically and emotionally
 Confine the mother to bed to prevent early rupture of membranes
 Close observations of temperature and blood pressure every four hours
 Observe foetal heart rate and maternal pulse quarterly to half hourly
You should always observe for signs of foetal and maternal distress. Accurately observe and record for
onset, strength, frequency and duration of the contractions. Closely observe the descent of the head
every one to two hours per abdominal palpation by the same midwife if possible. Encourage the mother to
pass urine every two hours and test for acetone to exclude acidosis.

Management of Trial of Labour

A vaginal examination should be done every four hours to assess the level of the presenting part, the
degree moulding and flexion, the dilation of the cervix (whether progressive or not), the consistency of the
cervix and the presence or absence of caput.
You should also check whether the membranes are intact or ruptured. Encourage adequate hydration by
giving intravenous 5% dextrose. Sedate the mother with pethidine or morphia in early labour to promote
rest, and reduce anxiety.
Undesirable Factors in Trial of Labour

Undesirable occurrences include:

 Rupture of membranes
 Colour of liquor is meconium-stained
 Uterine action is abnormal
 Abnormal presentation, where there is a change from vertex to brow
 When the presenting part fails to descend in spite of good uterine contraction
 When there are signs of foetal or maternal distress
Trial of labour may result in spontaneous vaginal delivery, assisted vaginal delivery by either forceps or
vacuum, or caesarean section due to complications.