Vaginal Birth After Cesarean Research Articles

Trial of labor after cesarean in women with diabetes in pregnancy stratified by fetal size

Cesarean delivery rates are increasing nationally and encouraging trial of labor after cesarean (TOLAC) in appropriate candidates is one means to achieve reduction in this outcome. One potential polarizing source of candidates for trial of labor are women with diabetes, likely due to high rates of fetal overgrowth and medically indicated delivery. We aim to quantify rates and safety of TOLAC and successful vaginal birth after cesarean (VBAC) in women with diabetes in pregnancy.

A Losing Game? – Recent trends in success rates of vaginal birth after Caesarean Section

Increasing rates of elective repeat cesarean section and reducing rates of vaginal births after previous cesarean (VBAC) are contributing to the increasing trend in cesarean delivery worldwide. Success rates of VBAC vary between continents, countries and institutions. While attempting VBAC is not without risk, it can be safely achieved with tremendous patient benefit. We examined how the rate of successful trials of labor after cesarean delivery has changed in recent years, in order to give patients and medical professionals an up to date perspective on VBAC.

Castor oil for labor initiation in women with a previous cesarean section: a double-blind randomized study

Objective: To evaluate the efficacy of castor oil in initiation of labor in women who had one previous cesarean section. This study was conducted as a trial to increase the rate of vaginal birth after cesarean (VBAC) and decrease the rate of elective repeated cesarean section (ERCS). Methods: A double-blinded randomized controlled study was conducted in an Egyptian University Hospital from July 2019 to July 2020. The participants were 70 pregnant women who had one previous cesarean section, singleton pregnancy in cephalic presentation, with a Bishop score ≤6 attempting to perform a trial of labor. Sixty mL castor oil was administered to group A and 60 mL sunflower oil was administered to group B (as a placebo) for initiation of labor at the start of week 39. Primary outcomes were the percentage of women entering the active phase of labor within 24 h after receiving castor oil or placebo and the number of successful VBAC deliveries. Results: Labor started in 16 patients (45.7%) within 24 h in the castor oil group and in 3 patients in the placebo group (8.5%), while the rate of successful VBAC was 65.7% (23 patients) in the castor oil group and 48.5% (17 patients) in the placebo group. Conclusion: Castor oil appears to be an effective, low-cost, and non-harmful method for the initiation of labor in patients with a previous cesarean section.

Case report: Is mid-trimester cesarean section an unrecognized risk factor for accidental extension to the lower uterine segment?

Purpose: Hysterotomy extension at the time of cesarean section is frequent and associated with severe blood loss, risk of transfusion, and unplanned hysterectomy. Cesarean section during the second stage of labor is the most important riskfactor.Case report: We describe a case of a 35-year-old gravida 4 para 1 at 26+1 weeks gestation who underwent a repeat cesarean section. An unintentional hysterotomy extension led to severe blood loss. The patient was discharged on day 4 after the operation in stable condition.Conclusion: Hysterotomy extension is associated with higher maternal morbidity and mortality. Blunt expansion of the hysterotomy and a reverse breech extraction are associated with a lower uterine tear rate.

Unusual Case of Uterovesical Polyp in a Patient Following Repeated Caesarean Section

NE is a 36yr old petty trader who has had four previous caesarean sections. She went for her routine abdominal ultrasonography at 36weeks of her fifth pregnancy and an incidental posterior bladder polypoid mass was found with a normal singleton fetus. Patient declined cystoscopy but accepted exploration of bladder at same time with a caesarean section. At Surgery, a polyp was found arising from the lower uterine segment traversing the thin posterior bladder wall into the bladder. The polyp was carefully dissected out and separated from bladder. Bladder and uterus were repaired, and patient had uneventful recovery.

Epidemiology of uterine rupture among pregnant women in China and development of a risk prediction model: analysis of data from a multicentre, cross-sectional study

ObjectivesTo describe the epidemiology of uterine rupture in China from 2015 to 2016 and to build a prediction model for uterine rupture in women with a scarred uterus.SettingA multicentre cross-sectional...

Relationship of Flamm Geiger Scores with Success Vaginal Delivery

Association Between Flamm Geiger Score And The Success Of Vaginal Delivery. Vaginal Birth After Cesarean (VBAC) is vaginal delivery on woman with history of cesarean delivery. A statement by Cragin (1916), “Once a cesarean, always a cesarean”, has been a growing paradigm in the community which makes VBAC not a common practice. Flamm Geiger Scoring System is used to predict the likelihood of success in VBAC. The purpose of this research was to find out the association between Flamm Geiger score and the success of vaginal delivery. This research was an analytic observational study with cross sectional design. The population of this research were all patients that underwent delivery in dr. Mohammad Hoesin General Hospital Palembang from January to December 2014 and the sample were all delivering patient with history of cesarean delivery.The data were taken from patient’s medical record and analyzed using Chi Square test or its alternative test (Fisher’s Exact Test). From 92 samples, there were 25 patients (27,2%) succeeded in undergoing VBAC and 67 patients (72,8%) delivered with repeated cesarean. There was an increasing probability for a successful VBAC ranging from 0% in samples with a score of 0-2 to 100% in samples with a score of 8-10. The result showed that there was an association between Flamm Geiger score and the success of vaginal delivery (p=0,000). There is association between Flamm Geiger score and the success of vaginal delivery in dr. Mohammad Hoesin General Hospital Palembang from January to December 2014.

Maternal Outcomes and Complications after Repeated Cesarean Sections among Zagazig University Hospital Patients

Maternal Outcomes and Complications after Repeated Cesarean Sections among Zagazig University Hospital Patients

Women's views of birth after cesarean section

Vaginal birth is a safe mode of childbirth for the majority of women after cesarean section (CS). However, data show that women who have undergone a CS are more likely to have an elective CS (ECS) than a vaginal birth after CS (VBAC) in many areas of the world. This study aimed to review the literature about women's mode of birth preferences and attitudes and the underlying reasons for, and factors associated with, their preferences. This is narrative literature review. PubMed/MEDLINE and Scopus databases were searched, limiting the results to non-interventional studies published between 1990 and 2020. Twenty-one articles were included in the analysis. The review found 34 different factors that influence women's preferences. Five factors influenced both VBAC and ECS preference, depending on the study. The most common factors having a dualistic effect on preference were: medical staff recommendation, doctor's opinion, and fear of pain. The most common factors were: desire to experience natural childbirth, faster/easier recovery, support from doctor's, and midwife's opinion. Among the factors influencing the preference for ECS, two were particularly prominent: predictability, controllability and comfortability of CS and the belief that CS is safer for the baby and/or mother. Our review showed that there are a variety of factors that influence women's preference for the mode of delivery after CS. Some of these have a dualistic effect according to the study. The key to making an informed decision regarding the mode of delivery is communication with medical professionals.

Compare the Outcomes of Subcutaneous Drains versus No Drains in Patients with Repeated Cesarean Section

Objective: The aim of this study is to compare the outcomes of subcutaneous drains versus no drains in patients with repeated cesarean section. Study Design: Randomized control trial Place and Duration: Conducted at Gyne & Obs Department, Shahida Islam Teaching Hospital Lodhran, during from 8-01-2020 to 8-08-2020. Methods: Total 90 pregnant women with repeated cesarean section were presented in this study. Patients were aged between 22-50 years. Detailed demographics of enrolled cases including age, body mass index, gestational age and parity were recorded after taking informed written consent. Patients were categorized into two groups, group I had 45 patients with subcutaneous drain and 45 patients of group II were without drain. Post-operative outcomes were assessed and compared among both groups. VAS was used to compare pain among both groups. SPSS 22.0 version was used to analyze the data. Results: Mean age of the patient in group I was 30.6±8.44 years with mean BMI 33.08±5.26 kg/m2 but in group II mean age was 29.03±7.37 years with mean BMI 31.12±11.58 kg/m2. Mean gestational age in group I was 37.9±3.9 weeks and in group II mean gestational age was 37.3±2.7 weeks. There was no any significantly difference in parity among both groups. Post-operative mean haemoglobin in group I was lower 7.9±1.6 gm% as compared to group II 8.11±0.4 gm%. Mean pain score in group I was 6.8±4.7 and in group II was 8.2±4.11. Prevalence of wound infection was greater in group II 5 (11.1%) as compared to group I 3 (6.7%). Hospital stay was shorter in group I 9.7±2.11 days as compared to group II 10.8±1.14 days. Frequency of superficial SSI and wound seroma were significantly higher among patients of group II. Conclusion: In this study we concluded that those patients who received subcutaneous drain undergoing cesarean section resulted low post-operative pain with fewer chances of wound infection as compared to the patients undergoing C-section without drain. Except this frequency of SSI and hospital stay was shorter among patients of drain group. Keywords: Cesarean, Drain, Wound Infection, Superficial Surgical Site Infection, Pregnant Women

Management of Placenta Accreta in Patients with Repeated Caesarean Section in Tikrit

Management of Placenta Accreta in Patients with Repeated Caesarean Section in Tikrit

The impact of family physicians in rural maternity care.

Reduced access to maternity care in rural areas of the United States presents a significant burden to pregnant persons and infants. The objective of this study was to estimate the impact of family physicians (FPs) on access to maternity care in rural United States hospitals, especially where other providers may not be available. We administered a survey to 216 rural hospitals in 10 US states inquiring about the number of babies delivered from 2013 to 2017, the types of delivering physicians, and the maternity services offered. We calculated the percentage of rural hospitals in our sample where FPs performed vaginal deliveries, cesareans, and vaginal births after cesarean (VBACs), and the percentage of all babies delivered by FPs. We estimated the distance patients would have to travel for care if FPs were not providing care locally. The final study population consisted of 185 rural hospitals. FPs delivered babies in 67% of these hospitals and were the only physicians who delivered babies in 27% of these hospitals. FPs provided VBAC at 18% and cesarean birth services at 46% of the rural hospitals, but with wide geographic differences. Many patients would have to drive an average of 86 miles round-trip to access care if those FPs were to stop delivering. Family physicians are essential providers of maternity care in the rural United States. Family Medicine residency programs should ensure that trainees who intend to practice in rural locations have adequate maternity care training to maintain and expand access to maternity care for rural patients and their families.

Higher risk of hemorrhage and maternal morbidity in vaginal birth after second stage of labor C-section.

This study evaluated the association between timing and indication for previous cesarean section (C-section) and its association with postpartum risks for adverse maternal outcomes, primarily postpartum hemorrhage (PPH) in vaginal birth after cesarean (VBAC). This retrospective case-control study examined women following term vaginal delivery in a university-affiliated medical center between 2008 and 2018. Postpartum complications were compared between women who had their first VBAC and a control group comprised of women who had vaginal delivery without prior C-section. Additional analysis was performed to evaluate the association between the timing of previous C-section and the severity of postpartum adverse outcomes. Of the women meeting the inclusion criteria (n = 2879), 1,455 had VBAC and 1,424 were in the control group. Overall, significant postpartum complications, primarily PPH, were observed in the VBAC group compared to controls. Women who underwent C-section during second-stage of labor experienced higher PPH rates and increased drop in hemoglobin levels compared to women who underwent C-section during the first stage of labor or an elective C-Sect.(4.3 ± 0.9g/dL vs. 2.8 ± 1.1g/dL vs. 2.4 ± 0.8, p = 0.033). Concomitant increased need for blood transfusion (8.1% vs. 3.5% vs. 2.9%, respectively, p < 0.0001) and uterine atony (12.6% vs. 6.2% vs. 4.4%, respectively, p = 0.009) were also observed. No significant differences were demonstrated in other postpartum adverse effects evaluated. VBAC is associated with higher rates of postpartum complications, primarily PPH. The risk is significantly increased in VBAC following a second stage cesarean section. This data should be taken into consideration in the management of laboring women after C-section.

Audit of Caesarean Sections in a Single Centre: Analysis of its Frequency and Indications

Background: Caesarean section serves a substantial parameter of comprehensive emergency obstetric and neonatal care and it is a package of care that groups together basic emergency obstetric care as well. Objective: To evaluate the frequency and indications of caesarean section in a tertiary care hospital. Methodology: This cross-sectional study was conducted in the department of Obstetrics and Gynaecology, Bahawal Victoria Hospital, Bahawalpur from June to November 2018. The records of all the women delivering either vaginally or by caesarean section during the study period were retrieved. Age, socioeconomic status, parity, type of delivery, and indications for which caesarean sections were noted. Data was analyzed by SPSS version 20. Results: A total of 4575 deliveries were conducted during the study period. Out of these, 2605 (57%) had caesarean sections, and 1970 (43%) delivered vaginally. Maternal age ranged from 20 to 40 years. The most common reason for caesarean section was repeat caesarean section (22%) followed by fetal distress (21%). Conclusion: This study revealed that there is a high frequency of caesarean section in tertiary care hospital, and the most common reasons for caesarean section were repeat caesarean section and fetal distress. The departmental protocols and SOPs must be made for indications of caesarean section. Adherence to standard guidelines and protocols for managing labor is required.

Determinants of Successful Vaginal Birth After Caesarean Section at Public Hospitals in Ambo Town, Oromia Region, Central Ethiopia: A Case-Control Study.

BackgroundThe World Health Organization recommends a caesarean section (CS) rate at health facilities from 10 to 15%, but the rate is higher at most of the institutions in different countries, including Ethiopia resulting in negative health-related and economic consequences. Vaginal birth after caesarean section (VBAC) is a safe and appropriate choice to decrease the rate of CS. Though the success rate is 60–80%, the number of mothers who experience the trial of labor is decreasing and the overall CS rate is rising. There is also limited information on determinants of successful VBAC in Ethiopia. Therefore, the study aimed to identify determinants of successful VBAC at public hospitals in Ambo town.MethodsA Facility-based retrospective unmatched case-control study was employed at public hospitals in Ambo town, Ethiopia, from June 1 to July 1, 2020. A systematic random sampling technique was used to select cases (n=74) and controls (n=221). The data were collected using a structured questionnaire and it was filled IN by reviewing the client’s medical record. The data were entered into Epi Info and exported to SPSS for analysis. Bivariate and multivariable logistic regression analysis was carried out for data analysis. Finally, statistical significance was determined based on the odds ratio with its 95% confidence interval and a p-value of <0.05.ResultsMothers whose age was less than 25 years and 25–29 years (AOR: 8.88; 95% CI 3.03, 26.03) and (AOR: 5.37; 95% CI 2.28, 12.66), respectively, mothers who had a history of previous successful VBAC (AOR: 3.01; 95% CI 1.47, 6.13), had a history of previous spontaneous vaginal delivery (AOR: 3.85; 95% CI 1.84, 8.05) and cervical dilation ≥4cm at admission (AOR: 2.05: 95% CI 1.14, 3.67) were independent determinants of successful VBAC.ConclusionThe study identified that past and present obstetric conditions played a significant role in the success of VBAC. Therefore, health workers have to consider those predictors while counselling and choosing mothers for trial of labor after caesarean section (TOLAC).

ULTRASONOGRAPHIC EVALUATION OF LOWER UTERINE SEGMENT THICKNESS IN PREGNANT WOMEN WITH PREVIOUS CESAREAN SECTION: A SYSTEMATIC REVIEW

Background: Nowadays it’s a big problem of lower uterine thickness in pregnant women that causes a lot of problems. Lower uterine segment thickness is a strong predictor for uterine scar defect in women with prior caesarian section. Lower segment cesarean section (LSCS) rates are raising throughout the world. Women with previous one cesarean can undergo either the trial of vaginal birth or elective repeat cesarean section in their next pregnancy. The study aims to assess the diagnostic accuracy of sonographic measurement of lower uterine segment thickness in pregnant women So there we are going to evaluate lower uterine segment thickness in pregnant women sonographically by using transabdominal and transvaginal approaches as well. Objective : To evaluate lower uterine segment thickness in pregnant women with previous caesarian section by sonography. Materials and Methods: An electronic data base search was performed through the searches using PubMed, Google Scholar, international Journal of Gynecology &amp; obstetrics and some other online journals and medical websites with the range from 2000-2021. All studies included in the research was in English language. Articles which had descriptive studies related to sonographic features of lower uterine segment thickness of pregnant women with C-section. Results: Research data of 200 patients in all studies showed that Transvaginal ultrasound provided greater reliability in LUS measurements than did transabdominal ultrasound. The use of three-dimensional ultrasound improved significantly the reliability of the LUS muscular thickness measurement obtained transvaginal Conclusion: We identified certain sonographic patterns that can accurately shows the lower uterine segment thickness in pregnant women with previous caesarian section. Keywords: LUS lower uterine segment thickness, Transabdominal and Transvaginal ultrasonography, Pregnancy, Caesarian Section DOI: 10.7176/JHMN/93-07 Publication date: September 30 th 2021

A comparison of antenatal prediction models for vaginal birth after caesarean section

An antenatal scoring system for vaginal birth after caesarean section (VBAC) categorises patients into a low or high probability of successful vaginal delivery. It enables counselling and preparation before labour starts. The current study aims to evaluate the role of Grobman nomogram and the Kalok scoring system in predicting VBAC success in Singapore. This is a retrospective study on patients of gestational age 37 weeks 0 day to 41 weeks 0 day who underwent a trial of labour after 1 caesarean section between September 2016 and September 2017 was conducted. Two scoring systems were used to predict VBAC success, a nomogram by Grobman et al. in 2007 and an additive model by Kalok et al. in 2017. A total of 190 patients underwent a trial of labour after caesarean section, of which 103 (54.2%) were successful. The Kalok scoring system (area under curve [AUC] 0.740) was a better predictive model than Grobman nomogram (AUC 0.664). Patient's age (odds ratio [OR] 0.915, 95% CI [confidence interval] 0.844-0.992), body mass index at booking (OR 0.902, 95% CI 0.845-0.962), and history of successful VBAC (OR 4.755, 95% CI 1.248-18.120) were important factors in predicting VBAC. Neither scoring system was perfect in predicting VBAC among local women. Further customisation of the scoring system to replace ethnicity with the 4 races of Singapore can be made to improve its sensitivity. The factors identified in this study serve as a foundation for developing a population-specific antenatal scoring system for Singapore women who wish to have a trial of VBAC.

The effect of mode of delivery and duration of labour on subsequent pregnancy outcomes: a retrospective cohort study.

To assess whether delivery mode and duration of labour in a first labour of spontaneous onset is associated with gestational length, delivery mode and neonatal outcome in the subsequent pregnancy. Retrospective analysis of prospectively collected data. 15 Maternity units in North West London (1988-2000). 30 840 women with spontaneous onset of labour in pregnancy 1 and a subsequent birth reported in the same database. Assessment of outcomes by mode of delivery in pregnancy 1, restricting the analysis to the difference in the gestational length between pregnancy 1 and 2. Gestational length, mode of delivery and neonatal unit admission in pregnancy 2. Caesarean section (CS) in the first or second stage of labour in pregnancy 1 was associated with pregnancy 2 being a median of 5 and 8 days shorter and a preterm birth rate of 6.0% and 10.1%, respectively, whereas following a normal or instrumental vaginal birth in pregnancy 1, the median duration was similar, with preterm delivery rates of 4.5% and 3.9%. In all, 56.2% of women with a CS in pregnancy 1 had a repeat CS and 12.5% of their babies were admitted to a neonatal unit, compared with 5.3% of women with vaginal birth. Longer labours were associated with shorter gestations in pregnancy 2. Compared with vaginal birth, an emergency CS in the first-term pregnancy is associated with a shorter gestational length, increased rate of repeat CS and increased risk of NNU admission in the next pregnancy. An emergency caesarean section in the first-term pregnancy affects the duration and outcome of the next pregnancy.

Temporal trends in obstetric anal sphincter injury from the first vaginal delivery in Austria, Canada, Norway, and Sweden.

Obstetric anal sphincter injuries (OASI) are severe complications that can cause considerable short- and long-term morbidity. Austria, Canada, Norway, and Sweden have similar socio-economic characteristics, and all four countries have access to national birth registers. In this study, we hypothesized that the incidence of OASI should be very similar for different obstetric scenarios in these four countries. Therefore, the aim was to compare the incidence of OASI in these four countries in primiparous women, with spontaneous or instrumental delivery (vacuum or forceps), and in women with a first vaginal birth after cesarean section (VBAC). Aggregated data on 1933930 vaginally delivered primiparous women and women with VBAC were retrieved from the birth registers gathered in Austria, Canada, Norway, and Sweden. The annual rate of OASI (ICD-10 codes O70.2-O70.3) was presented as the percentage of women with a spontaneous delivery, vacuum or forceps delivery, and a VBAC during the period 2004-2016. The incidence of OASI varied considerably between countries and over time. Canada and Sweden had the highest rates, and Austria and Norway the lowest. In Norway, the rate of OASI decreased consistently for all types of deliveries after introducing a perineal protection program in 2004 (p<0.001). During vacuum delivery, the incidence of OASI varied between countries from 4.1% to 15.5% across the study period. In Canada and Norway, the rate of OASI after a forceps delivery was similar in 2004 at ~20% and with differing trajectories to 24.3% (β 0.49) and 6.2% (β -1.15) (trend, all p<0.001) in 2016. This comparative register study suggests that there may be considerable potential for lowering the incidence of OASI. The perineal protection program implemented by Norway has been successful. Each country should critically, without prejudice, analyze their current clinical practices and rate of OASI and consider the best preventive strategy.

Vaginal birth after cesarean (VBAC): fear it or dare it? An evaluation of potential risk factors.

The consultation of women aspiring a vaginal birth after caesarean may be improved by integrating the individual evaluation of factors that predict their chance of success. Retrospective analysis of correlating factors for all trials of labor after caesarean that were conducted at the Department of Obstetrics of Charité-Universitätsmedizin Berlin, Campus Virchow Clinic from 2014 to October 2017. Of 2,151 pregnant women with previous caesarean, 408 (19%) attempted a vaginal birth after cesarean. A total of 348 women could be included in the evaluation of factors, 60 pregnant women were excluded because they had obstetric factors (for example preterm birth, intrauterine fetal death) that required a different management. Spontaneous delivery occurred in 180 (51.7%) women and 64 (18.4%) had a vacuum extraction. 104 (29.9%) of the women had a repeated caesarean delivery. The three groups showed significant differences in body mass index, the number of prior vaginal deliveries and the child's birth weight at cesarean section. The indication for the previous cesarean section also represents a significant influencing factor. Other factors such as maternal age, gestational age, sex, birth weight and the head circumference of the child at trial of labor after caesarean showed no significant influence. The clear majority (70.1%) of trials of labor after caesarean resulted in vaginal delivery. High body mass index, no previous spontaneous delivery, and fetal distress as a cesarean indication correlated negatively with a successful vaginal birth after cesarean. These factors should be used for the consultation of pregnant women.