Previous Lower Segment Caesarean Section Research Articles

Bone in the Womb: A Case Report of Endometrial Osseous Metaplasia

Introduction: Osseous metaplasia in the endometrium is a rare pathological condition characterised by the presence of mature bone, potentially leading to menorrhagia and infertility. The probable pathogenesis of this condition is metaplastic alterations in the endometrial stromal cells, leading to the formation of bony spicules. The gold standard for diagnosis of the condition remains histopathological examination, aided by radiological findings. Methods: This was a case report of a single case with evidence-based discussions. Informed consent was obtained. Case report: We present a case of a 26-year-old female with a previous lower segment caesarean section (LSCS) five years ago and an abortion, followed by dilation and curettage three years ago, presented with heavy menstrual bleeding. Trans-vaginal ultrasound revealed bright, highly echogenic and linear echo-reflective shadows in the endometrial cavity. The complete removal of bony spicules from the endometrium was done by hysteroscopy under sonographic guidance. On histology, a diagnosis of osseous metaplasia of the endometrium was given. Conclusion: The accuracy of the diagnosis is pivotal; it signifies a reversible factor contributing to infertility. Therefore, an accurate identification not only aids in appropriate treatment but also offers substantial relief and hope for those experiencing fertility challenges due to this condition.

Vaginal Birth after Caesarean Section (VBAC): A Case Report on V-Back in Saudi Arabia

Repeat caesarean sections increase the possibility of maternal morbidity. Worldwide, the need for a trial of labor after caesarean delivery is gaining more ground in selected cases. Here, we report a case of an unbooked 37-year-old multigravida, with a history of five (5) previous lower-segment caesarean sections who presented in spontaneous labor. A live male baby of 2900 grams was delivered following episiotomy. Post-partum, she was observed with normal findings and a serial follow-up ultrasound scan showed normal uterine contours and surrounding structures. As the evidence for the practice of vaginal delivery in women who underwent 2 or more previous LSCS are still fewer, this report intends to highlight the possibility of successful vaginal birth after multiple caesarean sections putting into consideration the optimal care of the parturient. The term ''V-back" was coined from the Roman numeral 'v' meaning five (5), the case here has had five (5) previous lower segment cesarean sections come "back" for spontaneous vaginal delivery.

Emergency Bilateral Internal Iliac Artery Ligation in Antepartum Haemorrhage with Complete Placenta Previa and Placenta Accreta at Previous Caesarean Scar Site: A Case Report

Implantation and placentation at the normal site are critical for a successful pregnancy. Many complications associated with pregnancy, which manifest late in pregnancy, such as preeclampsia and preterm labour, have been reported to have origins early during pregnancy with abnormalities in implantation and placental development. Placental abnormalities result from impaired embedding of the placenta in the endometrium, encompassing a wide range of placental pathologies associated with high maternal morbidity and mortality. Pregnancy-related complications such as Postpartum Haemorrhage (PPH) and hysterectomy have been closely linked to the Placenta Accreta Spectrum (PAS). PAS refers to the aberrant and invasive implantation of the placenta into the myometrium. Invasiveness in placenta accreta is marginal, followed by placenta increta (partial), placenta percreta (total), and placenta previa (covering the cervix). Here, the authors present a unique case report of an antenatal woman with antepartum haemorrhage, placenta previa, and placenta accreta at the previous Lower Segment Caesarean Section (LSCS) scar site, with massive PPH at 35 weeks, who benefited from an emergency LSCS with bilateral uterine and internal iliac artery ligation procedure, resulting in a life-saving outcome. The most common risk factors for PAS include prior caesarean section and curettage. The adhered placenta can lead to pelvic bleeding and necessitate an emergency hysterectomy. Therefore, it poses unique diagnostic and treatment issues, with the majority of cases requiring preterm termination of pregnancy.

Impact of Primary Cesarean Section on Grand Multiparous Women

Background: Grand multiparty is common obstetrical problem, in Sudan large families is desirable for cultural and religious backgrounds and higher incidence of grandmultipra is expected, the risk factors associated with adverse maternal outcomes have yet to be adequately investigated among grand multiparity need to delivered by primary cesarean section. Objective: The main objective was to determine impact of primary cesarean section on grand multiparous, it is indications and complications. Methodology: It was a descriptive prospective cross-sectional hospital-based study conducted at Omdurman Maternity Hospital during period October 2016 to March 2017. An interview questionnaire was used for data collection. Demographic and clinical data concerning personal history, parity, indications of primary cesarean section, type of Cs, maternal complication and neonatal complications were recorded. Also, multiparous less than five delivery, previous lower segment caesarean section, known medical disorders except anemia and twin pregnancy were excluded. Results: During the study period total of 113 grand multipara included, incidence of primary cesarean section in grand multipara was 10%. Indication in our study 22.1% due to malpresentation, fetl distress 15% and prolonged first stage 13.4%, prolonged second stage 12.4% and antepartum haemorrhage 11.5%. Postpartum haemorrhage developed in 9.7%, hysterectomy 1.8%, uterine tear 5.4% bladder injury fetal laceration 3.6%, spinal anesthesia headache 7%, post-partum pyrexia 5.3%, sepsis 4.4%, urinary tract infections were 2.7%. Conclusion: The finding in this study showed 10% incidence of primary cesarean section in grandmultipra. The most indications of primary cesarean section in grandmultipra malpresentation, fetal distress, prolonged first and second stage of labour. Most CS were emergency.

Comparison of Clinical and Radiological Findings for the Prediction of Scar Integrity in Women With Previous Lower Segment Cesarean Sections.

We aimed to compare the clinical and radiological findings to predict scar integrity in term antenatal mothers with a previous lower segment cesarean section (LSCS). This prospective study was conducted in the obstetrics and gynecology department of LN Medical College, Bhopal, India, from August 2020 to August 2021. We included all pregnant women with term gestation (37+0 to 42+0 weeks) who were admitted either for elective repeat LSCS or for emergency LSCS and had a history of a previous LSCS. A detailed history and clinical examinations were performed. We noted the presence of scar tenderness and conducted transabdominal ultrasound (USG) to assess the integrity of the uterine scar in all women. During surgery, the surgeon identified the lower uterine segment scar and graded it as normal, thinned-out, dehiscent, or ruptured. We calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for both clinical findings (scar tenderness) and ultrasound findings as predictors of scar integrity. A total of 60 pregnant women were included in the study. During a repeat cesarean section, we found a thinned-out scar in 26 women out of 60 (43.3%). Out of 60 women, 13 had scar tenderness, and among these 13 women, 12 had thinned-out scars intraoperatively. Forty-seven women had no scar tenderness; 14 had thinned-out scars intraoperatively. The sensitivity of scar tenderness as a predictor of a thinned-out scar was 46.2%, specificity was 97.1%, PPV was 92.3%, and NPV was 70.2%. Whereas the sensitivity of ultrasound scar thickness as a predictor of a thinned-out scar was only 19.2%, with a specificity of 94.1%, a PPV of 71.4%, and an NPVof 60.4%. Thus, we documented a significant correlation between intraoperative and clinical findings (κ = 0.46; p<0.05), but no agreement could be found between ultrasound and intraoperative findings (p>0.05). Clinically evident scar tenderness continues to be a useful parameter to predict intraoperative scar status.

Study of maternal and neonatal outcome in women with one previous lower segment caesarean scar in Raja Isteri Pengiran Anak Saleha Hospital (RIPAS)

Background: The rate of primary caesarean section (CS) is on the rise; it was 30.8% for primiparous women and 11.5% for multiparous women. A trial of vaginal delivery can prevent the risk of repeat CS. Aim: The study was to determine the success rate, and also maternal and neonatal implications of VBAC (Vaginal Birth after Caesarean), attempted in women with one previous lower segment caesarean section (LSCS). Materials and Methods: The retrospective and descriptive study was carried out in a tertiary care hospital, RIPAS Hospital, Brunei Darussalam, over a period of three months (from February 2010 to May 2010). All women with prior LSCS who are suitable for a trial of labour after the previous caesarean (TOLAC) were included in our study. Sixty-one pregnant women with a history of one previous LSCS were enrolled in the study. Results: In our study (38/61) 62.3% of patients had a successful VBAC, and (23/61) 37.7% had undergone a repeat emergency LSCS. In those who had the previous VBAC, cervical dilatation of &gt;4 cm at the time of admission and those who had the previous VBAC are significant factors for a successful VBAC. Conclusion: The trial of VBAC in selected cases has great importance in the present era of the rising rate of primary CS, as it has a considerable success rate and is not associated with serious maternal and foetal morbidity and mortality.

VBAC or elective CS? An exploration of decision-making process employed by women on their mode of birth following a previous lower segment caesarean section

BackgroundPart of the caseload of an Advanced Midwife Practitioner (AMP) service in a Northwest of Ireland maternity unit includes vaginal birth after caesarean section (VBAC) women. Despite evidence about VBAC being a safe option for women, the numbers attempting a VBAC remain small. This research was undertaken to give an insight into how VBAC eligible women opt for an elective repeat CS (ERCS) or VBAC birth. MethodsForty-four postnatal women with one previous CS who birthed between August 2021 and March 2022 were invited to participate in a qualitative study. Thirteen semi-structured interviews were undertaken in 2022. Thematic Analysis guided the analysis of the data and the findings are framed using the domains of the Socio-Ecological Model. FindingsDecision making in relation to ERCS and VBAC is complex. Women want accurate VBAC information and time for discussions. Decisions are influenced by the woman’s own confidence to birth naturally, family size, rite of passage to motherhood, control, previous birth experience, postnatal recovery and friends and family. DiscussionPrevious experience can influence but not predict the next mode of birth. However, there is no one script that healthcare professionals (HCP) can use for this decision making given the various factors that influence this. To meet women’s individual needs, HCPs should discuss VBAC suitability postnatally, offer VBAC antenatal clinics and specific VBAC classes. ConclusionDiscussions about suitability for VBAC should occur following the primary CS. Continuity of care (COC), time for discussions and VBAC supportive HCP should be an option for all of this cohort.

Validation of Grobman’s graphical nomogram for prediction of vaginal delivery in Indian women with previous caesarean section

To validate Grobman's nomogram for prediction of trial of labour after caesarean section (TOLAC) success in the Indian population. A prospective observational study of women with previous lower segment caesarean sections (LSCS) who were admitted for TOLAC between January 2019 and June 2020 at a tertiary care hospital We compared the Grobman's predicted VBAC success probability to the observed VBAC rate in the study population and devised a receiver-operator characteristics (ROC) curve for the nomogram. Among the 124 women with prior LSCS who chose TOLAC and were included in the study, 68 (54.8%) had a successful VBAC and 56 (45.2%) had a failed TOLAC. The mean Grobman's predicted success probability for the cohort was 76.7%, significantly higher in VBAC women versus CS women (80.6% vs. 72.1%; p 0.001). The VBAC rate was 69.1% with a predicted probability of >75% and only 42.9% with a probability of 50%. Women in the >75% probability group had a nearly similar observed and predicted VBAC rate (69.1% vs. 86.3%; p=0.002), and a greater number of women in the 50% probability group had successful VBAC than predicted (42.9% vs. 39.5%; p=0.018). The area under the ROC curve for the study was 0.703 (95% CI 0.609-0.797; p 0.001). Grobman's nomogram had a sensitivity of 57.35%, a specificity of 82.14%, a positive predictive value (PPV) of 79.59%, and a negative predictive value (NPV) of 61.33% at a predicted probability cut-off of 82.5%. Women who had a higher Grobman's predicted probability had greater VBAC success rates than those with low predicted probability scores. The prediction ability of the nomogram was highly accurate at higher predicted probabilities, and even at lower predicted probabilities, women did have good odds of delivering vaginally.

Vaginal birth after cesarean section prediction model for Jordanian population

The rate of cesarean section has increased significantly worldwide, creating a group of women with one lower segment cesarean section concerned about the mode of delivery in their future pregnancies. This group of mothers will face a complex discussion because the likelihood for a successful vaginal birth after cesarean section provided to them is a general one. The probability of having a successful vaginal birth is the cornerstone factor of the mothers‘ decision. Therefore, providing a case-specific likelihood that respects the characteristics of each pregnancy will refine counseling, lower the decision conflict, and improve the success rate of vaginal birth trials eventually improving maternal and fetal outcomes. This paper aims to develop a clinical decision support system to evaluate the individualized likelihood mode of delivery for pregnant women with a previous lower segment cesarean section based on their unique characteristics. The study included six hundred fifty-nine pregnant women, where three hundred twenty-seven records had missing values. Various pre-processing steps, including missing data imputation and feature selection, were applied to the original dataset before model development to improve the data quality. Missing values were handled first, then a feature selection process using a genetic algorithm was applied to select the relevant features and to exclude features that may have been affected negatively by missing data imputation. After that, four machine learning classifiers, namely Decision Tree, Random Forest, K-Nearest Neighbors (KNN), and Logistic Regression, were used to build the prediction model. The results showed that imputing missing values followed by feature selection was more efficient than deleting them since the Area Under the Curve (AUC) has increased from 0.655 to 0.812 using the KNN classifier.

Diagnostic Value of MRI in Placental Adhesive Disorders in Pregnancy

Abstract Background The spectrum of placental adhesive disorders (PAD) forms an important cause for emergency cesarean hysterectomy, requiring an accurate prenatal diagnosis for optimal obstetric management. Purpose The aim of this study was to assess the utility of magnetic resonance imaging (MRI) and to identify the individual MRI features that are most useful in the evaluation of PAD. Materials and Methods This was a retrospective review of the MRI of 24 women with abnormal placentation, confirmed using histopathology/intraoperative findings as the reference standard. Patients were categorized as negative or positive for PAD (placenta accreta, increta, and percreta) on MRI and compared with the reference standard. We assessed the diagnostic performance of MRI and the features that best correlated with the presence of PAD. Results Among the 24 women (mean age: 29.8 years) with risk factors, 16 had PAD (6 accreta, 7 increta, and 3 percreta). There was a history of previous lower segment cesarean section and placenta previa in 14 (87.5%). MRI could identify the presence of PAD in all (100% sensitivity) and its absence in three out of eight patients (37.5% specificity). The features with highest sensitivity were intraplacental dark bands (100%), myometrial thinning/loss of interface with myometrium (100%), placental heterogeneity (75%), and uterine contour abnormality (75%). Conclusion MRI is an important modality for the investigation of PAD in suspected cases, with excellent sensitivity and good accuracy. Identifying the presence of risk factors, low-signal-intensity bands, and thinning/loss of placental–myometrial interface will aid in its diagnosis.

A Retrospective Analysis of Antepartum Haemorrhage at Ain Shams University Hospital

Background: Antepartum haemorrhage (APH) can be described as a malicious phenomenon that is lying in wait to send their patients straight to the grave if it was not taken seriously from the start. Therefore, it has always been considered one of the commonest leading causes of maternal and perinatal morbidity and mortality. APH is defined as any bleeding from or into the genital tract after the period of viability and before the delivery of the baby. The aim of the current study was to assess maternal and neonatal outcome in patients with antepartum haemorrhage, prevalence of their different types, the associated risk factors and complications, and the different lines of management that were implemented. Methods: The present study was a retrospective observational study undertaken in the Obstetrics and Gynaecology department of Ain shams University Maternity and Women's Hospital, during a period of 3 months from August 1st, 2020 to October 31st, 2020. Total number of patients recorded were 99 cases of antepartum haemorrhage who have fulfilled the inclusion criteria. Data was recorded on the MS excel sheet for further analysis and processing using statistical package for social science, version 20.2 (SPSS inc., Chicago, Illinois, USA). Results: Total 3063 cases were registered during this period out of which 99 presented as APH and incidence of APH was found to be 3.23%. Placenta previa (67.68%) was the most common type of APH followed by placenta accreta (34.34%) and accidental haemorrhage (30.30%). The mean age of most women was 30.53±6.08 years and the mean gestational age was 34.96±2.96 weeks. High risk factors included previous Lower Segment Caesarean Section (LSCS), previous Dilation and Curettage (D&amp;C), hypertension, multiple pregnancies and mal-presentations. Most of the patients underwent preterm LSCS (61.62%) but 8.08% performed caesarean hysterectomy. Neonatal Intensive Care Unit (NICU) admissions recorded were 26.26%. Most fetal complications were due to prematurity. 66.6% of the patients required blood transfusion. Overall perinatal mortality was 5.05% and maternal mortality was zero. Conclusion: Women with APH have to be considered as high-risk pregnancy and need institutional supervision. Early diagnosis and management of the condition along with trained team of doctors are considered key strategies in avoiding APH related maternal, fetal and neonatal complications.

MATERNAL AND FETAL OUTCOMES IN PATIENTS WITH PREVIOUS CAESAREAN SECTION UNDERGOING TRIAL OF VAGINAL BIRTH

Background: Vaginal birth after cesarean section (VBAC) is one of the strategies developed to control the rising rate of cesarean sections (CSs). It is a trial of vaginal delivery in selected cases of a previous CS in a well-equipped hospital. In 1916, Cragin popularized the dictum, once a caesarean section, always a caesarean section. That was the era of the classical CS. In the present era of lower segment caesarean section (LSCS), cesarean-related morbidity and mortality are significantly reduced. The dictum now is once a caesarean section, always an institutional delivery in a well-equipped hospital. The reasons which led to the reversal of the old dictum are based upon the newer concepts of the assessment of scar integrity, fetal well-being, and improved facilities of emergency Cesarean Section. Successful vaginal birth after cesarean section is more comfortable than repeat emergency or elective cesarean section. Antenatal examinations are important in selection for trial of labor, while birth management can be difficult when the patients present at emergency condition. But there is an increased chance of vaginal birth with advanced cervical dilation.Nevertheless, a previous CS does cast a shadow over the outcome of future pregnancies. With present techniques and skill, the incidence of cesarean scar rupture in subsequent pregnancies is very low. The strength of the uterine scar and its capacity to withstand the stress of subsequent pregnancy and labor cannot be completely assessed or guaranteed in advance. These cases require the assessment and supervision of a senior obstetrician during labor. Hence, the present study is undertaken to assess the success and safety of VBAC in selected cases of one previous LSCS and to evaluate the maternal and fetal outcome in these cases. Methods:This prospective observational study was conducted over a period of 18 months from 1st August 2019 to 28th February 2021 at the department of obstetrics and Gynaecology, tertiary care hospital Pune, Maharashtra, India. After achieving ethic committee approval, informed consent of patients enrolled for the study taken, a thorough history and physical examination was done as per proforma. Cases were evaluated thoroughly to collect maternal age, gestational age at admission, association of success rate of VBAC and Parity, Mode of delivery, whether instrumentation was required, indication of previous LSCS, indication of caesarean section in repeat emergency caesarean section, history of prior vaginal delivery, interpregnancy interval. Maternal and fetal outcomes in both successful VBAC and emergency caesarean section were observed.Data collected in structured pro-forma, entered in Microsoft Office Excel format, and statistical analysis was performed using SPSS software. The data so collected was presented with graphical representation. Results: Out of 65 patients undergoing TOLAC, a total of 51 patients had successful vaginal birth and for 14 patients emergency caesarean section was needed. Therefore, the success rate of VBAC in this study in 78%. The most common indication of failed TOLAC was fetal distress. Factors affecting success of TOLAC seen in the study were inter-pregnancy interval, fetal weight and previous caesarean section done for non-recurrent indications. No significant fetal or maternal morbidity was observed in this study. There was no fetal and maternal mortality. Conclusion:Trial of labor after one caesarean section should be undertaken in selected patients in well-equipped hospitals where facilities to deal with emergencies are available.Despite the risks, trial of labor after caesarean remains safer option for many patients as there are fewer complications with less maternal morbidity and will lead to a successful outcome in a high percentage of cases.

Frequency Of Vaginal Birth After Caesarean Section And Its Fetomaternal Outcome.

Vaginal birth after caesarean section (VBAC) is associated with reduced blood loss and transfusions, fewer infections, and fewer thromboembolic events as compared to caesarean delivery. The current rate of repeat caesarean after one previous caesarean is above the WHO standard of 15%. We aimed to determine the occurrence of VBAC and to determine the occurrence of feto-maternal outcomes in successful VBAC cases so that trials of VBAC can be given to carefully selected patients to reduce the rate of repeat caesarean section. The Combined Military Hospital (CMH) Rawalpindi's Obstetrics and Gynaecology department conducted this cross-sectional study from March 20 to September 19, 2021. After obtaining ethical committee approval, data was collected using a non-probability, consecutive sampling technique from 150 patients on a self-developed structured proforma. Patients between the age range of 20-35 years with a history of previous lower segment caesarean section, having gestational age between 37-41 weeks and who presented in spontaneous labour were included in this study. After taking informed consent, all women were given a trial of labour and the outcome of the trial was noted. Women were followed for the feto-maternal outcomes. The gathered information was analysed using SPSS version 25.0. Post-stratification, a p-value of 0.05 or lower on the chi-square test was deemed statistically significant. Following a C-section, 28.67% of patients experienced successful vaginal births. PPH was found in 2.32%, scar dehiscence in 0.0%, low birth weight babies in 16.28%, APGAR score <7 at 1 minute was 23.26% and NICU admission as 9.30% in women undergoing vaginal birth after caesarean section. Appropriate selection of patients for the trial of VBAC can help reduce the higher rate of repeat caesarean section after a previous caesarean section and increase the chances of successful vaginal birth.

Validation of the Grobman model for successful vaginal birth after cesarean section in Jordanian women

BackgroundTo validate both models of Grobman nomogram (The antenatal and the intrapartum model) for predicting successful intended Vaginal Birth After Caesarean delivery (VBAC) in a Jordanian population.MethodsA retrospective study has identified all live, singleton, term, cephalic pregnancies with a previous lower segment cesarean section who opted for a Trial Of Labour After Caesarean Section (TOLAC) between January 2014 to December 2020. Five variables were used for the antenatal model, while ten variables were used for the intrapartum model. Two sets of patients were created: one for the antenatal model and the other for the intrapartum model. The predicted probability for each woman was calculated and compared with the successful VBAC for each category. The predictive ability was assessed with a receiver operating characteristic, and the area under the curve (AUC) was determined.ResultsThere were seven hundred and fourteen complete cases for the antenatal model and six hundred ninety-seven for the intrapartum model. Our population's overall number of VBAC is 83.89% for the antenatal group and 82.92% for the intrapartum group. The mean predicted probability for a successful intended VBAC using the antenatal and intrapartum models were 79.53 ± 13.47 and 78.64 ± 14.03, respectively. The antenatal and intrapartum predictive models ROC had an AUC of 65% (95% CI: 60%-71%) and 64% (95% CI: 58%-69%), respectively.ConclusionsBoth models are validated in the Jordanian population. Adapting the antenatal model as supporting evidence can lead to a higher rate of TOLAC.

Guillain-Barre Syndrome in a Patient Posted for Elective Caesarean Delivery: An Anaesthetic Dilemma

Guillain-Barre syndrome (GBS) is an acute polyneuropathy most commonly associated with acute flaccid paralysis which may be associated with sensory and autonomic neuropathy. Antecedent infection may trigger an immune response which may cause a cross reaction leading to demyelination and degeneration of axons in nerves. Here we present a case of a 28 year old female, G2P1 at 37 weeks of gestation with a history of previous lower segment caesarean section (LSCS) and oligohydramnios with suspected Guillain-Barre syndrome posted for elective LSCS. She presented with dribbling of saliva from angle of mouth and inability to close both eyes with slurring of speech since 2 days. MRI brain was advised which showed no specific changes. Neurology evaluation was done and Guillain-Barre syndrome with isolated facial diplegia was suspected. Due to risks associated with general anaesthesia and succinylcholine in this patient, a decision was made to proceed with a low dose spinal anaesthesia. Once administered, the level of subarachnoid block was noted to be at T6. The caesarean section proceeded uneventfully with no major hemodynamic changes. A healthy baby girl was delivered and patient was noted to have full motor and sensory recovery in the post-operative period. Providing anaesthesia to patients with Guillain-Barre syndrome can be very challenging. Meticulous pre-anaesthetic planning is needed. A thorough pre-anaesthetic evaluation considering risks and benefits of each modality of anaesthesia is crucial before anaesthetizing these patients.

Predictors of Repeat Cesarean Section in Women with One Previous Lower Segment Cesarean Section: A Retrospective Study from Malaysia.

The rates of repeat cesarean section (CS) among women with previous CS are increasing worldwide. The predictors of a repeat CS can vary across different populations. To determine the predictors of repeat CS among women from Malaysia with one previous lower segment CS (LSCS) who underwent trial of labor (TOLAC). This retrospective cohort study included women with one previous LSCS who followed up and delivered their current pregnancy at Hospital Universiti Sains Malaysia (USM), Kelantan, Malaysia, between January 01, 2016, and December 31, 2017. Women with singleton pregnancies were included while those who had a history of classical CS, current pregnancy with preterm birth, non-cephalic pregnancy, lethal fetal anomalies, uterine rupture, and severe preeclampsia or planned for elective CS were excluded. Logistic regressions were performed. The study included 388 women who underwent TOLAC and successfully gave childbirth through vaginal birth after cesarean (VBAC) (n = 194) or emergency LSCS (n = 194). Factors significantly associated with repeat CS were no history of vaginal delivery (adjusted odds ratio (aOR): 2.71; 95% confidence interval (CI): 1.60, 4.60; P < 0.001), estimated fetal weight ≥3500 grams (aOR: 4.78; 95% CI: 2.45-9.34; P < 0.001), and presence of meconium-stained liquor (aOR: 2.40; 95% CI: 1.33-4.35; P = 0.004). The above-mentioned predictors of a repeat CS among women from Malaysia with one previous LSCS who underwent TOLAC can be useful for clinicians in making an informed decision.

To Try or Not to Try: A Questionnaire Study among Women with Previous Lower Segment Cesarean Section.

The recent increase in the cesarean section (CS) rate worldwide has led to global concerns and vaginal birth after CS (VBAC) as an effective way to reduce the CS rate. In this study, our main aim was to know about various factors that help women make their preferred mode of delivery following a previous CS. This was a questionnaire-based study conducted in the Department of Obstetrics and Gynecology, All India Institute of Medical Sciences (AIIMS), Jodhpur, among 200 women with previous one lower segment CS (LSCS). Elective repeat cesarean delivery (ERCD) was found to be more among uneducated women and those who had complications in their previous babies. The most common reason for opting for ERCD was fear of labor pains. Women who were counseled by senior doctors were more likely to opt for a trial of labor after cesarean section (TOLAC). Improving the education levels of mothers, counseling about advantages associated with vaginal birth, counseling by senior obstetrician, and information regarding labor analgesia can decrease CS rates.

Clinico-epidemiological profile of women with high-risk pregnancy utilizing antenatal services in a rural primary health center in India

Objective: Early detection and effective management of high-risk pregnancies can substantially contribute to the reduction of adverse maternal and fetal outcomes. This study aimed to determine the prevalence and clinical profile of women with high-risk pregnancies in rural areas who utilize antenatal services in a primary health center (PHC). Materials and Methods: A retrospective analysis was carried out over a six-month period by reviewing the mother and child protection cards maintained at the PHC's Maternal and Child Health Center. During the study period, 950 pregnant women were registered, of whom 793 were included in the study based on the completeness of the records. Data analysis was performed using the licensed Statistical Package for the Social Sciences (SPSS) software version 21.0. Results: The prevalence of high-risk pregnancy among the antenatal women was 272 (34.3%) with 95% CI [31.1-37.7]. Of the 272 women, 240 (88.2%) had a single high-risk factor, while 32 (11.8%) had more than one high-risk factor. The major factor contributing to high-risk pregnancy was hypothyroidism (43.7% with 95% CI [37.9-49.6]), followed by a previous lower segment Caesarean section (LSCS) (19.1%). Conclusion: The study found that the prevalence of high-risk pregnancies was 34.3% in this rural setting. The majority of high-risk pregnancies were due to hypothyroidism, followed by more than one previous LSCS or abortion. Further research is required to track high-risk pregnancy outcomes and investigate the newborn thyroid profile of women with hypothyroidism.

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.

Risk factors for cesarean section in women of urban Puducherry, India: A matched case–control study

Cesarean section (CS) is generally performed either to ensure maternal and child safety when vaginal delivery is not possible. The WHO has indicated that CS rates of more than 10% are considered overutilization. Increased CS rates can cause an increase in postpartum antibiotic treatment and longer hospital stay. In this research, we conducted a matched case–control study, including all women who gave birth through CS and resided in the study area over a 3-year period before the survey as cases and similar age- and year-matched women who had normal vaginal delivery during the same period as controls. The data were collected using a semi-structured pro forma through personal interviews and verified with discharge cards. We obtained a sample of 140 women (70 matched cases and controls) as study participants. Our results show that unadjusted analysis revealed socioeconomic status, history of gestational diabetes mellitus, previous lower segment CS (LSCS), and malpresentation emerged as risk factors, whereas in the adjusted analysis, we observed that previous LSCS (aOR 45.4 [4.3 – 483.6]), malpresentation (aOR 11.0 [1.6 – 73.8]), and belonging to middle (aOR 3.3 [1.0 – 10.8]) and upper class (aOR 23.55 [CI: 1.2 – 463.8]) remained as independent risk factors. Our study identified independent risk factors for CS that needs to be tackled for bringing down the CS rates.