Outcome Of Pregnancy Following A Previous Lower Segment Caesarean Section: A Five Year Study At The Nnamdi Azikiwe University Teaching Hospital Nnewi (2002-2006).

Abstract

Background: A previous ceasarean section is an important variable that influences patient management in subsequent pregnancies. A trial of vaginal delivery in such patients is a feasible alternative to a secondary section, thus aiding to reduce the ceasarean section rate and its associated co-morbidities. Objective: To evaluate outcomes of vaginal delivery after a previous ceasarean section at Nnamdi Azikiwe University Teaching Hospital Nnewi from Jan. 2002 – Dec. 2006. Design: Retrospective/Descriptive. Materials And Methods: The records of 768 patients who qualified for vaginal birth after a ceasarean section (VBAC) were collected and reviewed from January 1st 2002 –December 31st 2006 Results: Seven hundred and sixty eight patients with a previous lower segment caesarean section operation were allowed a trial of vaginal delivery. 59.5 %( n=457), had successful vaginal delivery, while 40.5 %( n = 311) had repeat caesarean. Of the 59.5% who had vaginal delivery, 443 patients had spontaneous vertex delivery. 10 patients had vacuum extraction while 4 had forceps delivery. Three patients, 0.7% (n=457) had ruptured uterus, while (12/311) 3.9% had uterine dehiscence in the repeat caesarean section group. Haemorrhage complicated 2.6 %(12/457) cases in the vaginal delivery, while 14.5% (45/311) of patients had hemorrhage in the repeat caesarean section.` The perinatal mortality rate was 19.7/1000 for the vaginal delivery and 22.5/1000 for the repeat caesarean section. Conclusion: Trial of vaginal delivery can result in excellent outcome in well selected patients in areas where women have aversion for abdominal delivery and this has helped reduce the rate of caesarean section in our environment Keywords : Previous caesarean section, Trial of vaginal delivery, VBAC. Tropical Journal of Medical Research Vol. 11 (1) 2007: pp. 25-28