Indication For Previous Caesarean Section Research Articles

Vaginal Birth after Cesarean Score for the Prediction of Successful Vaginal Birth after Cesarean Section – A Prospective Observational Study

Aim: The aim of this study was to evaluate the demographic and obstetrical factors affecting the chances of vaginal birth after cesarean (VBAC) delivery and to develop a scoring system for the prediction of same. Materials and Methods: It was a prospective observational study done over a period of 1 year. A total of 100 term pregnant women with previous one lower-segment cesarean section (LSCS) fulfilling the criteria for a trial of labor were recruited for the study. As 23 patients refused to undergo trial of labor after cesarean (TOLAC) in early labor, 77 women formed the study group. Parameters assessed to predict successful TOLAC were maternal age, body mass index (BMI), history of prior vaginal delivery, interdelivery interval, indication of previous cesarean section, gestational age, type of labor, Bishop's score, and expected baby weight. Scores 0–2 were given, and the mean score obtained was correlated with the outcome of TOLAC. Results: Successful vaginal delivery occurred in 57.14% (44/77) of women. BMI ≤30 kg/m2 (P = 0.004), parity ≤ 3 (P = 0.005), Bishop's score >4 (P = 0.000), spontaneous onset of labor at the time of admission (P = 0.001), and nonrecurrent indication of previous LSCS (P = 0.029) were found to be significantly associated with the VBAC. The probability of having a successful VBAC was 83.3% and 100%, with the VBAC score value of more than 18 and 20, respectively. Conclusion: The mean VBAC score of 18–20 by the current scoring system is beneficial in predicting the outcome. This can help in counseling the patient, relatives as well as health professionals to undergo labor trial to decrease the cesarean section rate in the current era.

VBAC: antenatal predictors of success.

To determine antenatal factors that may predict successful vaginal birth after Caesarean section (VBAC), to develop a relevant antenatal scoring system and a nomogram for prediction of vaginal birth after caesarean delivery. A non recurring indication for previous Caesarean section (CS), such as breech presentation or foetal distress, is associated with a much higher successful VBAC rate than recurrent indications, such as cephalopelvic disproportion (CPD). Prior vaginal deliveries are excellent prognostic indicators of successful VBAC, especially if the vaginal delivery follows the prior CS. A low vertical uterine incision does not seem to adversely affect VBAC success rates as compared to a low transverse incision. Maternal obesity and diabetes mellitus adversely affect VBAC outcomes. Foetal macrosomia does not appear to be a contraindication to VBAC, as success rates exceeding 50% are achieved and uterine rupture rates are not increased. An inter-pregnancy interval of <24 months is not associated with a decreased success of VBAC. Success rates decrease when interval increases. Twin gestation does not preclude VBAC. Post-dates pregnancies may deliver successfully by VBAC in greater than two-thirds of cases. There are few absolute contraindications to attempted VBAC. Attempted VBAC will be successful in the majority of attempted cases. (www.actabiomedica.it)

Analytical study of factors determining success rate of trial of scar (TOS)

Background: Cesarean section (CS) is the most commonly performed operation in modern obstetrics. To combat the increasing CS rates without facing any medicolegal controversies, one must be aware of the factors influencing the mode of delivery, intrapartum behavior, and associated maternal and fetal morbidity in these patients. This study is aimed for better understanding of these aspects, which would help in better patient selection during decision-making for mode of delivery. Objectives: To study the different factors affecting the mode of delivery including the indication of previous CS, success rate of trail of scar (TOS) in patients with previous CS. Materials and Methods: A prospective cohort study was carried out in the Department of Obsterics and Gyanecology, Shree Sayaji General (SSG) Hospital, Vadodara, India, from May 2011 to April 2012. All patients with previous lower segment CS admitted to SSGH (labor room and ward) were evaluated according to the protocol and pro forma of the study. Patients before 37 completed weeks of gestation with severe preeclampsia and ecalmpsia, severe anemia, and medical disorders (e.g., diabetes, heart disease) were excluded. Result: Of the 280 patients selected for the study, 165 delivered by a repeat CS and 115 had a vaginal birth after cesarean delivery (VBAC). Thus, incidence of VBAC was 41.07%. TOS was given to 160 patients (57.14%) with a success rate of 71.87%. While studying previous vaginal delivery, nonrecurrent indication of previous CS, dilation on admission >3 cm, adequate pelvis, faster average dilatation rate, augmentation of labor (p < 0.0001), and birth weight (p

Ki-67 proliferation index in patients with placenta previa percreta in the third trimester.

The purpose of this study was to investigate proliferative capacity of placenta previa percreta in the third trimester via evaluating Ki-67 proliferating index. The paraffin blocks of placental tissues, which were obtained from the patients who underwent hysterectomy for placenta previa percreta (n = 12, gestational age > 28 weeks), from legal abortions (n = 12, gestational age < 10 weeks), and of cesarean deliveries with the indication of previous cesarean section, without any complication (n = 12, gestational age > 38 weeks), between January 2011 and April 2013, were included into the study. The paraffin blocks of the patients were stained with Ki-67 (proliferating cell marker) immunohistochemically, and Ki-67 proliferation index levels were calculated. Ki-67 proliferation index levels were higher in patients with legal abortions than patients with placenta percreta or noncomplicated cesarean delivery group. However, any statistically significant difference was not detected between the percreta and noncomplicated groups (p > 0.05). The tissue samples of the patients with placenta previa percreta exhibited low proliferative capacity similar to the samples of normal placentation group.

Vaginal Birth After Caesarean Section: Review of Antenatal Predictors of Success

Objective: To determine antenatal factors that may predict successful vaginal birth after Caesarean (VBAC).Data Sources: The MEDLINE database was searched for all English-language articles describing the impact of various factors on outcomes when VBAC is attempted. Articles reviewed included published abstracts, retrospective and prospective studies, and meta-analyses.Criteria for Study Selection: Studies were included if they reported both a control group of pregnant women without the factor under evaluation and a study group with this factor, both undergoing a trial of labour (TOL). Other criteria included accountability for all individuals enrolled at study outset, and vaginal delivery rates in both study and control groups stated or easily calculated.Results: A nonrecurrent indication for previous Caesarean section (CS), such as breech presentation or fetal distress, is associated with a much higher successful VBAC rate than recurrent indications, such as cephalopelvic disproportion (CPD). Even with a history of CPD, two-thirds of women will have successful VBAC, though rates decrease with increasing numbers of prior CS. Prior vaginal deliveries are excellent prognostic indicators of successful VBAC, especially if the vaginal delivery follows the prior CS. A low vertical uterine incision does not seem to adversely affect VBAC success rates as compared to a low transverse incision. Maternal obesity and diabetes mellitus adversely affect VBAC outcomes. Fetal macrosomia does not appear to be a contraindication to VBAC, as success rates exceeding 50% are achieved and uterine rupture rates are not increased. Twin gestation does not preclude VBAC. Post-dates pregnancies may deliver successfully by VBAC in greater than two-thirds of cases.Conclusion: There are few absolute contraindications to attempted VBAC. Attempted VBAC will be successful in the majority of attempted cases.

Trial of scar or elective repeat caesarean section at maternal request?

In a study between 1 January 1996 and 31 December 1998 at Watford General Hospital, we identified all women who booked having had a previous caesarean section. Data on age, social class and previous obstetric history was extracted from the notes, as was mode of delivery. Of the 718 patients identified, 497 were considered suitable for trial of scar. Of these 221 (44·5%) requested repeat caesarean section. Age, social class and indication for previous caesarean section could not predict those who accepted trial of scar. Of the 60 women who had had a previous successful trial of scar 59 (98·3%) underwent trial of scar and of the 48 who had had a vaginal delivery prior to caesarean section 37 (77·1%) underwent trial of scar ( P < 0·01). Maternal request for caesarean section, without obstetric contraindication to trial of scar, accounted for 24·9% of all the elective caesarean sections undertaken in our unit.

Vaginal delivery in first pregnancy following a primary caesarean section.

A retrospective study was performed on 131 women who had trial of scar in their first pregnancies following a primary caesarean section. The vaginal delivery rate was 81.7% and this rate was not significantly influenced by the indication for the previous caesarean section. It is advocated that patients for trial of scar should be selected on individual merits rather than on the nature of the indication for previous caesarean section.