EDITORIAL COMMENT: Evaluation of trial of vaginal delivery after previous Caesarean section (trial of scar) is at the cutting edge of modern obstetric practice and so we offer no apology for the number of papers we accept for publication on this subject. Trial of scar has been practised successfully, and reported consistently from centres in the United Kingdom and Eire for decades, but recent interest stems mainly from the United States of America where Caesarean section rates of 20–30%, and the realization that the leading indication for Caesarean was ‘Previous Caesarean’, has resulted in the abandonment of the philosophy of ‘Once a Caesarean always a Caesarean’, a dictum attributed to Dr E. Cragin, in 1916, at a time when the Caesarean section rate was only about 1% and most were by the classical technique! This paper reports impressive results from a centre where electronic fetal heart monitoring and X‐ray pelvimetry were not available. The elective Caesarean rate (28.2%) was low and 82% of those having a trial of labour delivered vaginally — the incidence of uterine rupture was 0.7% (2 of 288), but readers please note that in this series trial of scar was not performed if induction of labour was required, and there was no oxytocin augmentation in cases of dysfunctional labour — 59% of the 401 patients with a previous Caesarean were delivered vaginally. Readers may be interested to compare these results with those at the Mercy Maternity Hospital, 1971–1984 — of 3,524 patients with a previous Caesarean section 2,337 (66.3%) had an elective Caesarean and trial of vaginal delivery was attempted in 1,187 (33.7%). Vaginal delivery occurred in 895 patients i.e. in 75.4% of those having a trial of scar which was only 25.4% of the 3,524 patients with a previous Caesarean. Uterine rupture occurred in 10 of the 1,187 patients having a trial of scar; the price paid (by fetus, mother and obstetrician) for vaginal delivery after previous Caesarean section can be excessive. Summary: Many studies from developed countries have shown that a trial of vaginal delivery after a Caesarean section can be a safe alternative to repeated Caesarean section when certain criteria are fulfilled. However, few data are available from developing countries where, in most cases, there is no electronic fetal heart rate monitoring, no information about the prior section and no X‐ray pelvimetry. At Gweru Hospital, 401 patients with a scarred uterus have been managed according to a standard protocol and 288 were allowed to have a trial of scar. The results show that the trial was successful in 235 mothers (82%) and there were only 2 uterine ruptures (0.7%). Postpartum morbidity was higher after Caesarean section than after vaginal delivery. Copyright © 1988, Wiley Blackwell. All rights reserved
