Abstract
It is now widely accepted that trial for vaginal delivery should be attempted unlessa genuine indication exists for C- section. Objective: To determine the efficacy of membranesweeping for onset of labor till 41 weeks of gestation and mode of delivery in patients withprevious one cesarean section (C-Section). Study Design: Randomized control trial. Setting:Department of Obstetrics & Gynaecology, Benazir Bhutto hospital, Rawalpindi. Period: Jan2008 to Dec 2008. Methods: Pregnant women with previous one C- section were randomlyallocated to Group-A (sweeping of membrane) and Group-B (no intervention) each having 55patients. There was no absolute indication of cesarean section in present pregnancy. Aftercomplete antenatal examination, tests like CBC, urine DR, BSR, urea, creatitnine, screening forhepatitis B and C were done. In group A, digital sweeping of fetal membranes was started a37 weeks and was done every 3rd day till she went into the labor or she reached 41 weeks. At41 weeks of gestation, if she did not go into labor, induction with prostaglandin or elective Csectionwas done depending upon the bishop score. In group B, patients awaited spontaneousonset of labor till 41 weeks. After 41 weeks induction with prostaglandin or elective C- cesareansection was done. Results: In Group A, 43 (78.18%) patients had onset of labour aftersweeping of membranes while 12 (21.82%) patients had no onset of labour. In Group-B, 28patients (50.90%) had spontaneous onset of labor while 27 (49.10%) had no onset of labours.In Group-A, 34 (61.82%) patients and in Group-B only 14 (25.45%) were delivered vaginally (pValue 0.001). In Group-A, lower segment cesarean section was done in 6 (10.91%) patientswhile in Group-B, 23 (41.82%) had cesarean section (p Value 0.001). Assisted vaginal deliverywas done in 15 (27.27%) in Group-A while 18 (32.73%) patients in Group-B had assistedvaginal delivery (p Value 0.533). Conclusions: In patients with previous one cesarean section,the efficacy of membrane sweeping in terms of onset of labor and normal vaginal delivery issignificantly higher as compared to patients who had no sweeping of membranes.
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