Emergency Repeat Cesarean Section Research Articles

Outcomes of Trial of Labor after a Cesarean Section in Bomet County, Kenya

Trial of labor after cesarean section (TOLAC) is recommended for women with one prior cesarean section. However, TOLAC positive outcomes depend on selecting candidates to achieve higher success rates. Most available TOLAC data to inform patient selection originates from developed countries, which limits a patient-centered TOLAC practice in low-resource settings. Thus, we used a prospective observational cross-sectional approach to assess the success rate of TOLAC and establish the maternal and fetal factors associated with successful TOLAC in 170 women with one previous scar at two referral hospitals in Bomet County, a low-resource setting in Kenya. The primary maternal and neonatal outcomes were compared between those who had a vaginal birth after a cesarean section (VBAC) and those who had an emergency repeat cesarean section (ERCS) following a failed TOLAC between October 2022 and June 2023. The TOLAC success rate was 48.2% with the most common indication for emergency repeat cesarean section being failure to progress (34.1%). Factors associated with successful TOLAC included inter-delivery interval >60 months (p-0.044), and parity 2-4 (p- <0.001). Breech presentation and non-reassuring fetal status (NRFS) as indications for previous cesarean section, were associated with a successful VBAC (p-< 0.001, 0.033). In contrast, a birth weight of >3500 g was associated with an increased risk of ERCS. Moreover, a failed TOLAC was associated with a prolonged (>4 days) hospital stay (p-0.012). Our findings suggest that with proper patient selection, TOLAC remains a viable option with better outcomes if successful. However, TOLAC candidates should be evaluated based on the contextual factors of a given setting, hence careful patient selection is recommended to improve outcomes associated with TOLAC.

Vaginal Birth after a Cesarean Section at Good Shepherd Mission Hospital at Tshikaji in Democratic Republic of the Congo (DRC)

Background: The success rate of vaginal birth after cesarean section with a single cesarean scar is greater than 50%, the lack of the information about the safety of vaginal birth after cesarean delivery pushes most of obstetricians to increase the num ber of cesarean sections following a previous cesarean section. Guidelines for Vaginal birth after cesarean (VBAC) indicate that TOLAC offers women with no contraindications and one previous transverse low-segment cesarean. The objective of the current study was to study the outcome of trial of labour after caesarean section (TOLAC), the indications for emergency repeat cesarean section and to determine the maternal and fetal prognosis in vaginal birth after caesarian section (VBAC) at Tshikaji Mission Hospital. Patients, Material and Methods: This is a retrospective study of the records of 126 women were selected to undergo the TOLAC in the department of gynecology and obstetrics at the Tshikaji Mission Hospital over the period from January 1st to December 31st, 2021. The data on demography, antenatal care, labour and delivery and outcomes were collected from the maternity unit of this hospital. The data were analyzed using SPSS version 2.0. Results: The TOLAC in 126 studied women. The course of work allowed vaginal delivery 107 parturient women, a success rate of successful VBAC of 85% after the TOLAC. The repeat emergency cesarean section was necessary for delivery in 15% of cases for failed TOLAC. There was no maternal mortality, but we recorded one fetal death or 0.8% of perinatal mortality, 2 cases of cicatricial dehiscence, the incidence of 1.6%. Maternal morbidity after delivery on cicatricial uterus was dominated by postpartum hemorrhages, with 19 cases or 15.1% of cases. Cervical dilatation of more than 3 cm at the time of admission, the parity more than 3 and were the significant factors in favor of a successful VBAC. Birth weight of more than 3500 g, fetal distress and malpresentation were associated with a lower success rate of VBAC. The TOLAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas. Conclusion: Pregnancy on a cicatricial uterus represents a high-risk pregnancy. Trial of VBAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas. There is a significantly high vaginal birth after caesarian section (VBAC) success rate among selected women undergoing trial of scar in Tshikaji Hospital. TOLAC remains the option for childbirth in low resource settings as Kasai region in DRC. Adequate patient education and counselling in addition to appropriate patient selection for TOLAC remain the cornerstone to achieving high VBAC success rate.

Partogram in trial of labor after cesarean section

Background: In recent decades, the proportion of caesarean sections to vaginal delivery has increased substantially for various reasons, and a trial of vaginal birth after a caesarean section may save many pregnant women from recurrent cesarean sections and their complications. Aim: Aim is to detect whether partogram is applicable in the monitoring of a trial of labor after cesarean section. Patients and methods: A cross sectional observational study was conducted at AL-ELWIYAH maternity teaching hospital. Partogram was studied for (200) term pregnancy patients with previous one cesarean section for a non-recurring cause. Both the advantages and disadvantages of vaginal birth after cesarean section and a repeat cesarean section were explained and an informed consent is obtained. Their partograms were studied and at any time during the trial if an indication of cesarean section appeared the trial would be abandoned and an emergency repeat cesarean section would be performed. Result: Among the (200) patients included in the trial the following results were obtained: (170) patients delivered vaginally hence success rate was (85%).

Preference of birth mode and postnatal health related quality of life after one previous caesarean section in three European countries

ObjectivesWomen who have had a caesarean section may have a preference for birth mode during their subsequent pregnancy, either ‘vaginal birth after caesarean’ (VBAC) or ‘elective repeat caesarean section’ (ERCS). A mismatch between the preferred and actual birth mode may result in an impaired postnatal Health Related Quality of Life (HRQoL). This study examined the associations between antenatal birth mode preferences, the actual birth mode and postnatal HRQoL in women with one previous caesarean section in three European countries. DesignProspective longitudinal survey, as a part of a cluster randomised trial (OptiBIRTH) SettingFifteen maternity units in three European countries: Germany (5), Ireland (5) and Italy (5). ParticipantsWomen (≥ aged 18 years) living in Germany, Ireland and Italy with one previous caesarean section. The sample consisted of 862 women with complete antenatal and postpartum data. MeasurementsWomen's preference for birth mode after one previous caesarean section was assessed at inclusion to the trial, and HRQoL was assessed antenatally and at three months postpartum using the Short-Form Six-Dimension health survey. Based on women's preferences and actual birth mode six groups were determined: “match VBAC-VBAC” (preference for vaginal birth, actual mode of birth vaginal birth), “match ERCS-ERCS” (preference for caesarean section, actual mode of birth elective repeat caesarean section), “match ERCS-EMCS” (preference for caesarean section, actual mode of birth emergency repeat caesarean section), “mismatch VBAC-ERCS” (preference for vaginal birth, actual mode of birth elective repeat caesarean section), “mismatch VBAC-EMCS” (preference for vaginal birth, actual mode of birth emergency repeat caesarean section) and “no preference”. Associations between the preferred and actual birth mode were examined using univariate and multivariate analyses. FindingsWomen with preference for vaginal birth but who gave birth by elective repeat caesarean section (mismatch VBAC-ERCS) had a lower postnatal HRQoL compared to women with a preference for vaginal birth who actually had a birth vaginally (match VBAC-VBAC, p = 0.02). Poor antenatal HRQoL scores (p < 0.01) and maternal readmission postpartum (p = 0.03) are cofounding factors for poorer postnatal HRQoL scores. Key conclusionsThe results show that women with a preference for a vaginal birth who gave birth by an elective repeat caesarean section had a significantly lower HRQoL at three months postnatal. The long-term consequences and psychological health of women who do not achieve a vaginal birth after caesarean require further consideration and research. Implications for practiceAttention should be given to the long-term impact of a mismatch in preferred and actual mode on the psychological health of women.

Status of Scar in Repeat Cesarean Section in a Tertiary Hospital

Introduction: In modern Obstetrics, with rising trends of primary Cesarean section (CS) for fetal and maternal interests, pregnancy over the scarred uterus is a challenge to all treating obstetricians. How better the cesarean scar is sutured, its exact fate in next pregnancy is still not measurable. Objective of this study was to evaluate the status of previous cesarean scar during repeat cesarean section (RCS) and calculate the maternal morbidity in those cases in a tertiary hospital.&#x0D; &#x0D; Methods: It was a descriptive, retrospective study conducted at department of Obstetrics of Lumbini Medical College Teaching Hospital. The study was conducted from 15th July 2014 to 14th July 2015. The data were retrieved from the department of Medical Records. Women undergoing RCS were enrolled. The status of scar was evaluated in terms of intact scar, scar rupture, scar dehiscence, thin lower uterine segment, scar placenta previa, and adhesions as indicator of scar integrity.&#x0D; &#x0D; Results: There were 534 (25.4%) CS among 2,098 deliveries during the study period. Ninety one (17.04%) of them were RCS. Elective RCS were 73.6% (n=67), and emergency RCS were 26.4% (n=24). Eighty two (90.1%) women had RCS once and 9 (9.9%) had RCS for second time. Scar was intact in 22 (91.6%), scar dehiscence in 1 (8.3%), scar with adhesions in 1 (8.3%) among emergency RCS and intact in 53 (91.3%) and scar with adhesions in 5 (8.7%) among elective RCS. Among nine women of two RCS, three (37.5%) had thin scar, five (62.5%) had well formed scar, seven (87.5%) had intact scar, and one (12.5%) had scar with adhesion. There was no scar dehiscence and no scar rupture in two RCS women. Adhesions were documented twice higher in women whose primary CS was undertaken outside our hospital. Placenta previa and placenta accreta each were found in two cases.&#x0D; &#x0D; Conclusion: Most of the scars of repeat Cesarean section were healthy with no scar rupture. We can consider trial of labor for scarred uterus with strict vigilance and in need, CS is always at option.

Pregnancy outcome after one previous caesarean section at a tertiary university teaching hospital in Tanzania

The aim of this study was to assess outcome of pregnancy in women with one previous caesarean section at Muhimbili National Hospital in Dar es Salaam, Tanzania. A cross sectional descriptive study was conducted at Muhimbili National Hospital (MNH) from 13th September 2006-2nd February 2007. All women with one previous caesarean section coming for delivery at MNH in that period were identified. Data on medical history, socio-demographic and obstetric characteristics, decision on mode of delivery, and pregnancy outcomes were collected. There were 3285 deliveries during the study period, out of which 365 (11%) women had one previous caesarean section. Almost half (48%) of the women with one previous caesarean section attended antenatal care in the dispensaries and health centres. Trial of scar was decided in 80 (21.9%) women. A total of 278 women had the decision for repeat caesarean section made on admission whereby 180 (64.4%) were for emergency caesarean section and 98 (35.6%) were for elective caesarean section. A total 52 women delivered vaginally, 44 after trial of the scar and eight among women decided for emergency repeat caesarean section on admission. The incidence of uterine rupture was 2% and perinatal mortality ratio was 55 per 1000 live birth. In conclusion, a significant proportion of women delivering at MNH had one previous caesarean section among which few underwent trial of scar. Half of the women attended antenatal care in the dispensaries and health centres. Women with previous caesarean section should be encouraged to attend hospitals providing comprehensive emergency obstetric care. The quality of intrapartum monitoring should be audited to improve maternal and newborn outcome.

Vaginal delivery after caesarean section.

In a prospective study of 318 consecutive pregnancies complicated by previous Caesarean section, 193 (61%) had an elective repeat Caesarean section, 125 (39%) had a trial of labour and 80 (64%) of these women achieved a vaginal delivery. The incidence of uterine rupture was 0.8% (1 of 125). The vaginal delivery rate was not influenced by the indication for the first Caesarean section (including cephalopelvic disproportion), birth-weight, health insurance status, use of epidural analgesia or oxytocin in labour. Perinatal morbidity was unaffected by the mode of delivery and maternal morbidity was comparable following elective and emergency repeat Caesarean section. Patients having a vaginal deliver spent significantly less time in hospital. We conclude that vaginal delivery after lower segment Caesarean section is safe and should be considered in most patients after a critical review of the indication for the first Caesarean section.

Prenatal Diagnosis of Fetal Seizure: A Case Report

A 35-yr-old woman carrying a 17-week-old fetus presented with right hydronephrosis and a single umbilical artery. Karyotyping was normal and targeted ultrasonography showed an otherwise normal fetus. After 28 weeks of gestation, the mother felt rapid, repetitive fetal movement and an ultrasound at 30 weeks of gestation revealed tonic clonic movements of the fetal trunk and extremities. At 36 weeks of gestation, an emergency repeat Cesarean section was performed because of a premature rupture of the membranes and a male infant weighing 4,295 gm was delivered. After birth, the infant continued to have movements suggestive of a generalized tonic clonic seizure. Brain computed tomography and magnetic resonance imaging revealed normal structures and an electroencephalography showed generalized suppression. Treatment with phenobarbital resulted in substantial improvement in the number of seizure episodes, however fine seizure-like movement continued in both of the hands, feet and in the tongue until the five-month follow-up. This is the first Korean report of a fetal seizure being diagnosed during the prenatal period.