Trial of labor after previous cesarean delivery (TOLAC) and association of BMI and previous vaginal delivery with frequency of VBAC

Haider Ghazanfar,Huma Tasleem

doi:10.3329/bjms.v15i4.21687

Haider Ghazanfar, Huma Tasleem

Open Access

https://doi.org/10.3329/bjms.v15i4.21687

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Abstract

Objectives: To determine the frequency of successful Vaginal Birth after One Cesarean Section in our tertiary care institution and to determine the causes of its failure.Material and Methods: This study was conducted in department of Obstetrics and Gynecology of Shifa International Hospital and Shifa Foundation Community Health Centre Islamabad Pakistan from Feb 2011 to Dec 2014. This study included 592 patients who presented in labor room emergency reception of Obs/Gynae department at term with previous one scar having fulfilled the laid down inclusion criteria for VBAC during ante-natal care. The patients were admitted in hospital and were allowed to proceed for spontaneous labor under vigilant monitoring on complications of trial of scar. Immediate emergency cesarean sections were performed, where indicated.Results: Out of 592 patients 70.7% were delivered vaginally after previous one cesarean section and 29.3% had emergency cesarean section. Leading indications for repeat cesarean section was fetal distress, failure to progress and scar tenderness. No maternal and fetal complication occurred in our study. The success rate of Trial of labor after one previous cesarean delivery was lower in obese (64.38%) as compared to non-obese women (82.06%) (p<0.001). Women with previous successful vaginal delivery had a success rate of 88.2% compared with 62.25% in women without such a history (OR 4.4; 95% CI 2.7-7.2 p <0.001).Conclusion: Vaginal birth after one lower segment cesarean section should be encouraged with vigilant monitoring provided no obstetric contra-indication to vaginal birth exists.Bangladesh Journal of Medical Science Vol.15(4) 2016 p.546-550

Highlights

The term cesarean delivery is a surgical procedure to deliver a baby through an incision in the uterus
A total of 592 pregnancies which fulfilled the selection criteria were included in this study and were allowed to proceed for vaginal birth after one Tasleem H, Ghazanfar H
The success rate of trial of labor after one previous cesarean delivery was lower in obese (BMI ≥30) (64.38%) as compared to non-obese women (BMI

Summary

Introduction

The term cesarean delivery is a surgical procedure to deliver a baby through an incision in the uterus. Over the time the Cesarean delivery rate has significantly increase over the time from 18.2% in 2002 to 30.3% in 20121 It is one of the most common obstetric surgeries performed all over the world[2]. The catch aphorism “Once a cesarean, always a cesarean” came from a paper published in 1916, entitled ‘Conservatism in Obstetrics’[4]. It was neither a prescription nor a recommendation but rather an observation and a caution to avoid a primary cesarean if at all possible, because it might doom the woman to surgical delivery in her future pregnancies. Caesarean sections were usually done for severe cephalo-pelvic disproportion and the classical incision in the muscular body of the uterus was almost universally used[5]

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