A prospective comparative study of a trial of labor after cesarean vs. elective repeat cesarean section (ERCS) in view of maternal outcomes

Abstract

Background: There has been a wide range of success rates reported for those achieving vaginal birth following a planned vaginal birth after cesarean (VBAC). Objective: (1) To find out the incidence of rupture uterus and dehiscence in patients with trial of labor after cesarean section, (2) to evaluate the incidence of vaginal delivery in women who had previously undergone a cesarean section, and (3) comparison of a trial of labor after cesarean with an elective repeat cesarean section (ERCS) in view of maternal outcomes. Materials and Methods: This prospective observational study was carried out in the Department of Obstetrics and Gynecology, PDU Medical College, Rajkot, Gujarat, India, from January 1, 2014 to June 30, 2015. Result: During the study period, 10,315 deliveries were noted, of which patients who underwent a previous cesarean section were 1,082. Among the previous cesarean cases, trial of labor was given for 222 of them, of which, successful VBAC was found in 136 (61.26%) cases, while in 86 (38.74%) cases, an emergency cesarean was performed. In 860 cases, ERCS was done. Incidence of rupture and dehiscence in trial of labor group was 4.5% (10 cases) and 2.7% (6 cases), respectively, while no rupture was noted in the ERCS group. Scar dehiscence was found in 8 cases (0.93%) in the ERCS group. In 2 cases among the trial of labor group, obstetric hysterectomy was performed for rupture, while in 2 cases, bladder injury was noted. No maternal morbidities were noted in the ERCS group. No mortality was recorded in the study period. Conclusion: Hence, decision for trial of labor or ERCS should be taken as per the patient’s choice, through detailed history and examination. Even though many studies showing success rate of VBAC higher, maternal morbidities associated complications of trial of labor are life threatening, and we conclude ERCS is safer when compared with VBAC in view of maternal outcome.