Objective : The purpose of this study was to clarify the obstetric factors of success in trial of labor after cesarean delivery (TOLAC). Methods : A retrospective review was made of the records of 82 consecutive women who had previously undergone a cesarean section and attempted vaginal delivery at Shinshu University Hospital from 2005 through 2012. The relationship between the obstetric factors and the ‘successful’ and ‘unsuccessful’ groups in TOLAC was investigated. Results : The successful rate in TOLAC was 78.0% (64/82), but 22.0% (18/82) of women were unsuccessful and required a cesarean section again. The significant predictive factors in successful vaginal delivery were history of vaginal birth before cesarean section and admission for onset of labor. The significant predictive factor in unsuccessful vaginal delivery was abnormal fetal cardiotocogram. Interestingly, cases with an interval of ≥ 36 months from previous cesarean section in the successful group were significantly more than those in the unsuccessful group. Conclusion : The factors of history of vaginal birth before cesarean section, admission for onset of labor, abnormal fetal cardiotocogram and the interval from previous cesarean section might help clinicians and patients in their decision-making for the method of delivery when it comes to pregnancy with a previous cesarean section.
An 85-year-old woman with pneumonia had a fresh tracheostomy for prolonged orotracheal intubation. On the 14th day after the tracheostomy, difficulty occurred when attempting to change to a fresh tracheostomy tube, creating a false passage and loss of the airway. After several unsuccessful attempts at changing the tracheal tube for about 5 minutes, we inserted a tracheostomy tube under the guidance of a curved metallic detector which was inserted in the inner space of the tracheostomy tube. The tracheostomy tube could then be reinserted easily and safely. It is suggested that the curved metallic detector may be of benefit when a tracheostomy tube needs to be changed before maturation of the tracheal cutaneous tract.