Abstract
Background and Objectives: To investigate the outcome in women with planned (VBAC) in comparison to Repeat Cesarean Section (RCS) and to those undergoing vaginal birth. Design and settings: Retrospective study, women with a history of one lower segment cesarean section (LSCS) admitted to Abha General Hospital for delivery from September, 2010 to February, 2011. Subjects and Methods: The demographic maternal and neonatal data and data concerning the course of delivery were reviewed in 418 women underwent trial of labor (TOL) and subjected to statistical analysis to study the predictive factors and outcome. All cases were divided into 3 groups, VBAC group (212 women), RCS group (206 women) and the neonates of the VBAC group were compared to those of a control group consists of 287 neonates who delivered vaginally. Results: The success rate of VBAC was 50.72%, with no uterine rupture or wound dehiscence. Failure to progress was the most common (40.2%) indication of RCS followed by fetal distress (29.9%). Young maternal age (P < 0.05), previous vaginal deliveries after CS (P < 0.05) and occiputo anterior position (P < 0.01) were significantly associated with successful VBAC. Neonatal Intensive Care Unit (NICU) admission was significantly higher in the RCS group (P < 0.001), while no significant difference was found between NICU admission in the VBAC and the control groups. Conclusion: VBAC should remain an available option. Informed consent, good reporting and thorough documentation of the VBAC decision are crucial. During TOL, continuous fetal monitoring and, ultrasound evaluation of the previous scar are recommended. Emergency CS should be considered if duration of the TOL is prolonged with non reassuring CTG.
Highlights
Quality improvement efforts, practice management skills, in addition to safe, ethical practices and the need for a focus on prevention are all necessary to optimize clinical outcomes
All cases were divided into 3 groups, Vaginal Birth After Cesarean (VBAC) group (212 women), Repeat Cesarean Section (RCS) group (206 women) and the neonates of the VBAC group were compared to those of a control group consists of 287 neonates who were delivered vaginally
Neonatal Intensive Care Unit (NICU) admission was significantly higher in the RCS group (P < 0.001), while no significant difference was found between NICU admission in the VBAC and the control groups
Summary
Practice management skills, in addition to safe, ethical practices and the need for a focus on prevention are all necessary to optimize clinical outcomes. Change based on adoption of national standards derived from Evidence-Based practice and randomized controlled trials (RCTs) alone may not always establish how diagnostic and therapeutic procedures work in clinical practice. For this reason, health care organizations must develop the tools to identify and adopt best practice and improve clinical outcomes locally [1]. The aim of this study was to investigate the outcome in women with planned Vaginal Birth After Caesarean (VBAC) in comparison to Repeat Cesarean Section (RCS) and to those undergoing vaginal birth, in attempt to build up a safer clinical pathway for management and improve the health-care delivery system in Abha General Hospital in the coming years
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