Repeat Cesarean Section Group Research Articles

A PROSPECTIVE STUDY ON THE MATERNAL OUTCOME IN CASES OF PREVIOUS ONE CESAREAN SECTION

Background and Objectives:Women with previous cesarean sections constitute a high-risk group in obstetrics. The study was conducted to determine the mode of delivery in a previous cesarean section group and maternalcomplications. Method:The study was a prospective observational study conducted in The NSCB Medical College, Jabalpur from January 2020 to June 2021. Cases with previous one cesarean section for outcome in present pregnancy were taken and Cases with gestation before 28 weeks and previous section > 2 were excluded. Result:A total of 384 cases presented with the previous one CS, TOLAC was given to 109 patients (28.38%) and 51.37% achieved VBAC in the TOLAC group. Women who were selected for repeat CS without a trial of labor were 275 (71.61%)and the most common indication being scar tenderness 28%. Post-op maternal complications and infectious morbidity were significantly higher in the repeat cesarean section group. Conclusion: Women given a trial of labor with careful monitoring and taken for emergency LSCS on minimal indication is the best answer to management with an expectant attitude and individualization of labor in patients who had one cesarean section is not only justifiable but represents a sound and conservative obstetrical practice.

Acceptance of Vaginal Birth After Caesarean Section Trial in Shree Birendra Hospital, Kathmandu, Nepal: A Descriptive Cross-sectional Study

Introduction: The rate of primary cesarean section is on the rising trend. Vaginal birth after cesarean section can be an alternative to reduce cesarean section worldwide. Antenatal examination and intrapartum monitoring are the most important factors for a vaginal birth after a cesarean section. This study aims to determine the acceptance of vaginal birth after cesarean section trial in a tertiary care hospital in Nepal.
 Methods: This is a descriptive cross-sectional study carried out in Shree Birendra Hospital, Kathmandu, Nepal, from March 2019 to March 2020. All pregnant women with a previous history of cesarean section meeting Royal College of Obstetrics and Gynecology criteria were included. A trial of labor was conducted on the patients who accepted vaginal birth after cesarean section.
 Results: A total of 85 cases with previous lower section cesarean section were included in the study. Out of which, 75 (88.2%) refused vaginal birth after cesarean section, and only 10 cases (11.8%) accepted to undergo a trial of labor. Five women (50%) had a successful vaginal birth. Complications were less among the vaginal birth after cesarean section group than the repeat cesarean section group. There was no maternal and neonatal mortality.
 Conclusions: The acceptance of vaginal birth after cesarean section is very low in this study. No complications were observed among vaginal birth after cesarean section in our study.

Maternal and perinatal outcomes of delivery after previous one or two cesarean section

The prevalence of cesarean deliveries is high in many parts of world. Vaginal birth after cesarean section (VBAC) is a trial of vaginal delivery in selected cases of a previous CS in a well equipped hospital. It offers distinct advantages over a repeat caesarean section, since the operative risks are completely eliminated, the hospital stay is much shorter and expenses involved are much less.To study the maternal and perinatal outcomes among women with previous Cesarean section at a tertiary care centre.This prospective study was carried out over a period of 12 months. 979 pregnant women with previous caesarean section were recruited in study. A detailed history was taken and mode of delivery decided as per the standard protocol. 636 patients underwent elective repeat LCSC.343 patients were given trial of labour out of which 226 delivered vaginally. Maternal and neonatal outcomes were notedThe rate of successful VBAC was 65.89%. Most common indications of repeat caesarean section were fetal distress and failure to progress. Post op maternal and neonatal complications were significantly more in repeat caesarean section group. Incidence of infectious morbidity was also higher in repeat cesarean group than VBAC group.Fetal morbidity and mortality due to trial of labor is comparable with the women laboring without a scar, trial of labour may be encouraged. women given trial of labour with careful monitoring and taken for emergency LSCS on minimal indication is the best answer to management of previous one or two CS.

A study of the determinants of success of trial of labour after cesarean (TOLAC) in a tertiary centre of Haryana

A study of the determinants of success of trial of labour after cesarean (TOLAC) in a tertiary centre of Haryana - IJOGR- Print ISSN No: - 2394-2746 Online ISSN No:- 2394-2754 Article DOI No:- 10.18231/j.ijogr.2019.067, Indian Journal of Obstetrics and Gynecology Research-Indian J Obstet Gynecol Res

Balloon catheter for induction of labor in women with one previous cesarean and an unfavorable cervix.

IntroductionWhen women with a previous cesarean section and an unfavorable cervix have an indication for delivery, the choice is to induce labor or to perform a cesarean section. This study aims to assess the effectiveness and safety of a balloon catheter as a method of induction of labor in women with one previous cesarean section and an unfavorable cervix compared with an elective repeat cesarean section.Material and methodsWe performed a prospective cohort study in 51 hospitals in the Netherlands on term women with one previous cesarean section, a live singleton fetus in cephalic position, an unfavorable cervix and an indication for delivery. We recorded obstetric, maternal and neonatal characteristics. We compared the outcome of women who were induced with a balloon catheter with the outcome of women who delivered by elective repeat cesarean section. Main outcomes were maternal and neonatal morbidity. Mode of delivery was a secondary outcome for women who were induced. Adjusted odds ratios (aOR) were calculated using logistic regression, adjusted for potential confounders.ResultsAnalysis was performed on 993 women who were induced and 321 women who had a repeat cesarean section (August 2011 until September 2012). Among the women who were induced, 560 (56.4%) delivered vaginally and 11 (1.1%) sustained a uterine rupture. Composite adverse maternal outcome (uterine rupture, severe postpartum hemorrhage or postpartum infection) occurred in 73 (7.4%) in the balloon and 14 (4.5%) women in the repeat cesarean section group (aOR 1.58, 95% confidence interval [CI] 0.85‐2.96). Composite adverse neonatal outcome (Apgar score <7 at 5 minutes or umbilical pH <7.10) occurred in 57 (5.7%) and 10 (3.2%) neonates, respectively (aOR 1.40, 95% CI 0.87‐3.48). Women who were induced had a shorter postpartum admission time (2.0 vs 3.0 days (P < 0.0001)).ConclusionsIn women with a previous cesarean section and a need for delivery, induction of labor with a balloon catheter does not result in a significant increase in adverse maternal and neonatal outcomes as compared with planned cesarean section.

Is it safe to have multiple repeat cesarean sections? A high volume tertiary care center experience.

Objective:To compare the obstetric outcomes of cesarean section in women who had a history of four or more previous cesarean sections with those who had a history of two or three previous cesarean sections.Methods:Total 1318 women who underwent repeat cesarean section between January 2013 and January 2016 were retrospectively reviewed. Of these, 244 (18.5%) had previously had four or more cesarean sections (multiple repeat cesarean section group) and 1074 (81.5%) had previously had two or three cesarean sections (control group). Demographic characteristics and obstetric outcomes were compared using the Independent t and chi-square tests.Results:The adhesion rate (p < 0.001), number of blood transfusion (p = 0.044), operation time (p = 0.012), length of hospital stay (p < 0.001) and tubal ligation surgery (p < 0.001) were significantly higher in multiple repeat cesarean section group compared to control group.Conclusion:Although multiple repeat cesarean section are asscociated with adhesion occurrence, higher number of blood transfusion, increased operation time and length of hospital stay, there is no remarkable difference in serious morbidity associated with multiple repeat cesarean section.

Analysis of the delivery mode results of repregnancy after cesarean section

Objective To explore the best choice mode of repregnancy after cesarean section.Methods 312 cases with repregnancy after cesarean section were divided into the repeat cesarean section (RCS) group (210 cases),vaginal birth after cesarean(VBAC) group (102 cases),and the first time cesarean(PCS)group(210 cases).The maternity delivery mode and outcome were observed and the relevant conditions (postpartum hemorrhage,the average length of hospital stay and hospital costs,etc.) were compared among the three groups.Results The trial production was in 144 cases,and vaginal delivery in 102 cases,the success rate was 70.83％.168 cases with direct vaginal delivery,the success rate was 53.85％.The postpartum hemorrhage of RCS group[(310.5 ± 30.2)ml] was significantly higher than that of VBAC group [(143.5 ± 25.2) ml] (U =7.55,P ＜ 0.01) and PCS group [(244.2 ± 28.3) ml] (U =20.4,P ＜ 0.05).The hospital stay time of RCS group [(7.5 ± 0.2) d] was significantly more than that of VBAC group[(3.0 ±0.3)d] (U =25.50,P ＜0.01)and PCS group[(6.6 ±0.6)d] (U=16.7,P ＜0.05).The hospitalization costs of RCS group [(4 451.5 ± 62.4) yuan] was significantly higher than that of VBAC group [(1 223.6±12.3)yuan](U=71.5,P＜0.01) and PCS group[(3 756.4± 54.6)d](U=25.2,P＜0.01).Conclusion Repregnancy after cesarean section is not absolute indications for cesarean section,vaginal birth is safe and feasible as long as the medical intensive care effectively,and it can reduce the rate of cesarean section. Key words: Caesarean section ; Pregnancy; Parturition

Outcome of trial of labor after cesarean section in women with past failed operative vaginal delivery

The objective of the study was to assess the outcome oftrial of labor after cesarean (TOLAC) in women with past failed operative vaginal delivery (OVD). A retrospective study of all women who underwent cesarean section (CS) because of a failed OVD in a tertiary medical center between 1996 and 2011. Women who had a subsequent delivery were identified, and the outcome of subsequent delivery was analyzed. Overall, 533 women underwent CS because of failed OVDduring the study period. A total of 204 women (38.3%) had a subsequent delivery, of whom 93 (45.6%) had a TOLAC and 111 (54.4%) had a repeat elective CS. The success rate in the TOLAC group was 61.3% (n= 57). The most common indication for repeat CSwas lack of progress (72.3%) among the 36 women in whom TOLAC failed (38.7%). The rate of postpartum hemorrhage and prolonged maternal hospitalization was lower in the TOLAC group than inthe repeat CS group (2.2% vs 10.8%, P= .02, and 0% vs 8.1%, P= .005). There were no cases of rupture or dehiscence of the uterinescar. Factors associated with failed TOLAC were the occiput-posterior position and prolonged the second stage as the indication for OVD in the index pregnancy, maternal age older than 30 years atthe time of subsequent delivery, and a birthweight in the subsequentpregnancy that is higher than the birthweight in the index pregnancy. TOLAC in women who underwent a previous CS because of a failed OVD is associated with a relatively high success rate compared with the reported success rates among women with past CS during the second stage of labor. This information and the risk factors for TOLAC failure can be used when counseling these women regarding mode of delivery in subsequent pregnancy.

How rational are indications for emergency caesarean section in a tertiary hospital in Tanzania?

The rate of caesarean section (CS) at Muhimbili National Hospital (MNH) in Tanzania has been on progressive increase for past three decades. Concerns have been raised if this increase is justified by rational decisions but no study so far has investigated this problem. The aim of the study was to find out whether decisions made for CS comply with a set of locally made standards, with an assumption that if the standards are met, then the increase in CS rate seen at MNH is genuine. The five most common indications for CS were identified from the obstetric electronic data base. Most common indications included obstructed labour, cephalopelvic disproportion (CPD), failure to progress, repeat CS and foetal distress. Criteria for the best practice for each indication were developed based on the National guidelines and local expert consensus. Information extracted from the case notes, antenatal cards and partographs were compared to the standard audit criteria and the decision judged as standard or substandard. Three hundred forty five women had a decision made for emergency CS. Repeat CS was the most frequent indication (30.2%), followed by obstructed labour (14.4%) and foetal distress (13.6%). Audit of 324 women's files showed that 30% of women had substandard decisions for CS mostly in the foetal distress group (59.1%) and least in the repeat CS group (9.1%). Among the-324 mothers with decision for emergency CS, 279 (86.1%) delivered by CS as decided and 45 (13.9%) delivered vaginally before CS could be performed. Women who delivered vaginally after decision for CS and the nulliparous women had significantly more substandard decisions compared to those delivered by CS and parous women respectively. In conclusion, a substantial proportion of decisions for emergency CS made in the hospital is substandard and may contain women in whom surgical intervention could be avoided. This calls for a need to improve quality of assessment and decision before performing CS.

Optimization of clinical outcome of women with previous one lower segment cesarean section

Background and Objectives: To investigate the outcome in women with planned (VBAC) in comparison to Repeat Cesarean Section (RCS) and to those undergoing vaginal birth. Design and settings: Retrospective study, women with a history of one lower segment cesarean section (LSCS) admitted to Abha General Hospital for delivery from September, 2010 to February, 2011. Subjects and Methods: The demographic maternal and neonatal data and data concerning the course of delivery were reviewed in 418 women underwent trial of labor (TOL) and subjected to statistical analysis to study the predictive factors and outcome. All cases were divided into 3 groups, VBAC group (212 women), RCS group (206 women) and the neonates of the VBAC group were compared to those of a control group consists of 287 neonates who delivered vaginally. Results: The success rate of VBAC was 50.72%, with no uterine rupture or wound dehiscence. Failure to progress was the most common (40.2%) indication of RCS followed by fetal distress (29.9%). Young maternal age (P < 0.05), previous vaginal deliveries after CS (P < 0.05) and occiputo anterior position (P < 0.01) were significantly associated with successful VBAC. Neonatal Intensive Care Unit (NICU) admission was significantly higher in the RCS group (P < 0.001), while no significant difference was found between NICU admission in the VBAC and the control groups. Conclusion: VBAC should remain an available option. Informed consent, good reporting and thorough documentation of the VBAC decision are crucial. During TOL, continuous fetal monitoring and, ultrasound evaluation of the previous scar are recommended. Emergency CS should be considered if duration of the TOL is prolonged with non reassuring CTG.

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

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

Vaginal birth after cesarean delivery: a group practice’s approach to minimizing failed trial of labor

Objective: Among women attempting a trial of labor (TOL) after a prior abdominal delivery, 60–80% accomplish a vaginal birth after cesarean (VBAC). McMahon and coworkers (N Engl J Med, 1996) have indicated that at a 60% success level for TOL, the remaining 40% incurred enough major complications that the scheduled repeat cesarean section group was less morbid overall. The same authors speculated that a success rate of 80% might be necessary for the TOL group’s morbidity to be superior. We sought to review our group’s patient selection experience during an interval when successful TOL consistently exceeded 80%. Methods: The study interval ranged from January 1995 through June 1997 and was limited to patients with one previous low transverse cesarean section. Rather than using administrative or charge-related diagnoses, we analyzed a departmental database that included each delivering physician’s selection of one of four VBAC categories: successful VBAC, unsuccessful VBAC, patient declined trial of labor, or physician advised against trial of labor. All deliveries were at a single institution and were performed by one of seven obstetricians in a group practice. Results: During the study interval, 332 women provided a history of a single previous cesarean delivery. Of these 332, a total of 173 attempted a TOL and 150 of the 173 (87%) were successful. Fifty-eight of the 332 (18%) declined a trial of labor despite being assessed as excellent candidates, and 101 (30%) were advised against a TOL by their physician. Most common reasons for physicians discouraging labor included malpresentation, fetal macrosomia, and clinically small pelvis. Complications for the 23 of 173 (13%) experiencing a failed TOL included 1 asymptomatic partial separation of a uterine scar and 4 cases of puerperal fever; neither transfusion nor hysterectomy was required. Conclusions: This study demonstrates that in a population of women with one prior cesarean delivery, it is possible for a group practice to achieve a TOL success rate exceeding 80%. In our opinion the managing physician selecting out those patients least likely to attain a successful TOL contributes to a low failed TOL rate. We speculate that an analysis for best practice patterns within our group might reveal information of value for future practice guidelines.

Breech presentation after cesarean section: Always a section?

A retrospective review of 71 breech deliveries after previous cesarean was done to determine the need for repeat cesarean section. Twenty-four (33.8%) women were allocated to the elective repeat cesarean section group and forty-seven (66.2%) patients were allocated to a trial of labor group. Thirty-seven (78.7%) were delivered of their infants vaginally. A total of 37 of the 71 women (52.1%) had successful vaginal deliveries. Neonatal morbidity did not differ for women who were delivered vaginally or by cesarean section. Maternal febrile morbidity was significantly higher in the cesarean section group than in the vaginal delivery group (p less than 0.001). On the basis of these data, a trial of labor seems reasonable in carefully selected cases of breech presentation after a previous cesarean section.