Abstract
The prevalence of cesarean deliveries is high in many parts of world. Vaginal birth after cesarean section (VBAC) is a trial of vaginal delivery in selected cases of a previous CS in a well equipped hospital. It offers distinct advantages over a repeat caesarean section, since the operative risks are completely eliminated, the hospital stay is much shorter and expenses involved are much less.To study the maternal and perinatal outcomes among women with previous Cesarean section at a tertiary care centre.This prospective study was carried out over a period of 12 months. 979 pregnant women with previous caesarean section were recruited in study. A detailed history was taken and mode of delivery decided as per the standard protocol. 636 patients underwent elective repeat LCSC.343 patients were given trial of labour out of which 226 delivered vaginally. Maternal and neonatal outcomes were notedThe rate of successful VBAC was 65.89%. Most common indications of repeat caesarean section were fetal distress and failure to progress. Post op maternal and neonatal complications were significantly more in repeat caesarean section group. Incidence of infectious morbidity was also higher in repeat cesarean group than VBAC group.Fetal morbidity and mortality due to trial of labor is comparable with the women laboring without a scar, trial of labour may be encouraged. women given trial of labour with careful monitoring and taken for emergency LSCS on minimal indication is the best answer to management of previous one or two CS.
Highlights
The prevalence of cesarean deliveries is high in many parts of world
Indication for prior section- Women with a non recurrent indication- for example, breech presentationhave the highest Vaginal birth after cesarean section (VBAC) rate of nearly 90% (Wing, 1999) 10.Prior second-stage cesarean delivery can be associated with second- stage uterine rupture (Jastrow, 2013) 11
Out of 979 cases, 636 cases underwent elective repeat cesarean section, looking into the circumstantial safety of the mother and fetus. 343 were allowed for a trial of labour, out of them women who had failed TOL were taken for emergency LSCS for various indications
Summary
The obstetric practice before 1970’s was dictated by the phrase, “Once a caesarean always caesarean”. 4 Maternal mortality associated with caesarean section can be 3 times that of vaginal delivery (Esteves-Pereira et al 2016). 3. No other uterine scar or previous rupture. Type of prior uterine incision- Women with one prior low transverse cesarean have the lowest risk of scar rupture. 2. Indication for prior section- Women with a non recurrent indication- for example, breech presentationhave the highest VBAC rate of nearly 90% (Wing, 1999) 10.Prior second-stage cesarean delivery can be associated with second- stage uterine rupture (Jastrow, 2013) 11. 3. Number of prior Caesarean section- There is a double or triple rate of rupture of uterus in women with two compared with one prior transverse cesarean. Medical Induction of Labour with PGE2 (dinoprostone) is associated with an increased risk of uterine rupture. A perfect neonatal outcome being every obstetrician’s goal, a perinatal loss in caesarean section delivery causes much concern
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