Trial Of Labour After Caesarean Section Research Articles

Evaluating Successful Pregnancy Outcome in Women Undergoing Trial of Labour after Caesarean Section (TOLAC)

Objective: To determine the successful pregnancy outcome in women who opted for trial of labour after one lower segment transverse caesarean section (TOLAC). Study Design and Setting: Descriptive cross-sectional study. Department of Obstetrics and Gynaecology, Combined Military Hospital Abbottabad, from Nov 2022 to April 2023. Methodology: 54 pregnant women were included in our study who had previously undergone one lower segment caesarean section more than 18 months back. They were booked at their first visit, briefed and counselled for trial of labour after caesarean section (TOLAC ), and were advised to await spontaneous labour till 40 completed weeks of gestation and in case of failure of onset of labour then for induction of labour. Data was collected in terms of successful vaginal birth/repeat caesarean section and fetomaternal outcome. Results: In our study, 54 women agreed for trial of labour who had one caesarean section more than 18 months back. Vaginal birth was successful in 39 women (72.22%). Gestational age, BMI, and age of the woman did not show any significant effect on trial of labour. Factors leading to successful outcome include previous vaginal delivery, spontaneous onset of labour, favourable bishop score, women who are keen for vaginal delivery. Conclusion: The study concluded that most pregnant women prefer labour trial after one CS. Adequate counselling and briefing of women reduce their anxiety, and help them to make decisions about their preferred mode of delivery.

External validation of prediction models for vaginal delivery after the trial of labour among women with previous one caesarean section – A cohort study

ObjectiveTo externally validate three predictive models (the Grobman model (2007), the Zhang model (2020), and the Grobman model (2021)) for identifying women with increased chances of a successful trial of labour after caesarean section (TOLAC). MethodsThis retrospective observational cohort study was conducted in a tertiary teaching hospital from 2018 to 2021. Individual probabilities were calculated for women with previous one caesarean section who underwent TOLAC at term, using the predicted probabilities from the logistic regression models. The primary outcome of this study was vaginal delivery following attempted TOLAC. The predictive ability of the models was assessed using the area under the receiver operative characteristics curves (AUC) and a calibration graph. ResultsOf 1515 eligible women who underwent TOLAC, we found an overall rate of successful TOLAC of 60.3 %. No significant difference was noticed in adverse scar outcome and neonatal morbidity while comparing successful and failed TOLAC. The discriminative ability of Grobman-2007 and Grobman-2021 and the Zhang model were fair to poor with the AUC of 0.54(95 % CI 0.51–0.57), 0.62(95 % CI 0.59–0.65) and 0.66(95 % CI 0.63–0.69) respectively. The agreement between the observed rates of TOLAC success and the predicted probabilities for all three models was poor. ConclusionThe performance of all three models predicting success after TOLAC was poor in the study population. A population-specific model may be needed, with the addition of factors influencing the labour, such as the methods of induction, which may aid in predicting the outcome.

Experience of VBAC in A Private Hospital

Background: Vaginal birth after cesarean section (VBAC) for a non-recurring indication has been described by several authors as safe & having a success rate of 60-80%. VBAC increases the possibilities of subsequent vaginal deliveries & reduces the rate of repeat cesarean section with associated postoperative morbidity. Objective: To estimate the success rate & risks of an attempted vaginal birth after one cesarean delivery (VBAC). Materials & Methods: The study was conducted as a private hospital based cross sectional descriptive study from July2021 to December 2021. Total 176 patients were admitted with history of prior CS in this study. Among these cases common indications of primary CS were caesarean delivery on maternal request (CDMR), fetal distress, less fetal movement etc. All cases with previous one cesarean section who delivered vaginally within the study period comprised the study population. Women with 1 previous cesarean section, singleton pregnancy, cephalic presentation & term gestation were included in this study. However, women with history of 2 or more C/S, previous uterine surgery like myomectomy & classical C/S were excluded. Result: Out of 37 cases enrolled in the study, 24 (64.86%) successfully delivered vaginally without any complication. 11(29.73%) cases needed repeat cesarean section and 2 (5.41%) cases had to undergo emergency cesarean section for scar tenderness, those were found to be uterine scar rupture. Conclusion: This study suggested that trial of labour after caesarean section (TOLAC) was effective in decreasing CS in this study population. TOLAC and VBAC can be offered to pregnant women without contraindication. To establish the finding definitively, large multicenter prospective studies are required. Bangladesh J Obstet Gynaecol, 2022; Vol. 37(1): 28-31

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.

Study of Trial of Labour after Caesarean Section (TOLAC)

Study of Trial of Labour after Caesarean Section (TOLAC)

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.

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

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

Vaginal delivery after previous one lower segment caesarean section at a tertiary care hospital

Aims & Objectives: To find out the predictors of spontaneous term vaginal birth after a previous one lower segment caesarean delivery. Materials & Methods: A prospective study was conducted in the Department of Obstetrics & Gynecology, SMS Medical College, and Jaipur from March 2015 to October 2016. 120 pregnant women with a history of one previous Lower segment caesarean section (LSCS) were enrolled in the study. Results: In our study, 60% cases had a successful Vaginal birth after caesarean section (VBAC) and 40% underwent a repeat emergency LSCS for failed trial of labour after caesarean section. Anterior position of cervix, cervical dilatation ≥ 3cm, effacement ≥ 60-70%, vertex position at or below the ischial spine at the time of admission in labour room were significant factor in favoring a successful VBAC. The incidence of scar dehiscence was 5.83%. There was no maternal or neonatal mortality. Conclusion: Trial of labour after caesarean section (TOLAC) can be given in selected cases with good monitoring of Fetal heart sound (FHS) and progress of labour under supervision of trained staff at a tertiary care hospital.

How does uterine contractile activity affect the success of trial of labour after caesarean section, and the risk of uterine rupture? An exploratory, blinded analysis of a cohort from a randomised controlled trial.

ObjectiveTo investigate the impact of uterine contractile activity on the outcome of trial of labour after caesarean section (TOLAC).DesignSecondary, blinded analyses of a prospective TOLAC cohort.SettingTwo labour wards, one in a university tertiary hospital and the other in a central hospital.PopulationA total of 194 TOLAC parturients with intrauterine tocodynamometry during labour.MethodsAnalysis of intrauterine pressure, frequency of contractions and baseline tonus of uterine muscle in 30‐minute periods for 4 hours before birth.Main outcome measuresPrimary outcome: uterine contractile activity during TOLAC. Secondary aims: contributors associated with failed TOLAC and uterine rupture.ResultsTOLAC succeeded in 74% of cases. Uterine contractile activity, expressed as intrauterine pressure, was significantly higher in successful TOLAC compared with failed TOLAC (210 versus 170 Montevideo units). The statistically significant risk factors of failed TOLAC, after multivariate regression analysis, were prolonged gestational age, reduced cervical dilatation at admission and lower mean intrauterine pressure. In cases of uterine rupture, contractile activity did not differ from that in failed TOLAC. Cervical ripening with a Foley catheter appeared to be a risk factor for uterine rupture, as well as cervical dilatation <3 cm at admission. The incidence of total uterine rupture was 2.6% (n = 5).ConclusionsWomen with successful vaginal birth had higher uterine contractile activity than those experiencing failed TOLAC or uterine rupture despite similar use of oxytocin. Induction of labour with a Foley catheter turned out to be a risk factor for uterine rupture during TOLAC among parturients with no previous vaginal delivery.Tweetable abstractDuring VBAC the response to oxytocin, assessed as intrauterine pressure, is greater and adequate, in contrast to failed TOLAC.

Epidural analgesia at trial of labour after caesarean section. A retrospective cohort study over 12 years

Background: Epidural analgesia (EA) in patients at trial of labour after caesarean section (TOLAC) remains a matter of controversy due to fear of masking symptoms suggestive of uterine rupture. The aim of this study was to evaluate if EA during TOLAC increases the risk of maternal and foetal complications. Methods: This study utilized a database containing details of deliveries collected prospectively by a Swiss obstetric study group over a 12-year period. The cohort was dichotomised between women with and without EA during delivery. Contingency tests and Spearman rank correlation were used for statistical analyses. A p &lt; 0.05 was considered significant. Results: Of 4401 women, 1736 (39.4%) were delivered with EA (Group 1) and 2665 (60.6%) without (Group 2). Overall, 56.1% of the women delivered vaginally. Group 1 had a higher vaginal operative delivery birth rate (24.9% vs 9.5%, p &lt; 0.0001) while Group 2 showed a greater rate of emergency caesarean section (49.1% vs 31.50%; p &lt; 0.0001). The overall incidence of uterine rupture was 20/4401 (0.45%) with no difference between groups. Conclusions: EA during TOLAC appears to improve vaginal delivery without increasing maternal and foetal morbidity or uterine ruptur.

Factors that influenced pregnant women with one previous caesarean section regarding their mode of delivery

BackgroundDuring the last decades, the rate of caesarean section is increasing and this can increase the mortality and morbidity. Up to one third of the caesarean sections are attributed to the elective repeat caesarean section (ERCS). This study aims to evaluate attitudes and factors affecting the choice of pregnant women with one previous caesarean section regarding their mode of delivery in their second pregnancy. By assessing these attitudes, this study can help the efforts in developing strategies to increase the rates of vaginal delivery. Material and methodsA cross-sectional design was conducted by a structured questionnaire on 166 pregnant women who had delivered once by caesarean section for their first pregnancy and were in the third trimester of their second pregnancy. Any women with an absolute indication for caesarean section was excluded. The study comprises women who attend the clinic at our center in Northern of Jordan. Proper statistical tests were performed to assess the association between the choice of delivery and selected demographic and clinical factors. ResultsAbout 55.4% responded that they would choose ERCS (n = 92) and the remaining participants chose trial of labour after caesarean section (TOLAC) (n = 74). Fear of pain was the most common reason for choosing caesarean section, accounting for 55.4%. Interestingly, our study did not show a significant association between the mode of delivery and demographic factors, such as age, educational level and occupation. The single independent significant factor influencing patients’ choice that our study revealed was “being informed about the complications of TOLAC”. The choice of TOLAC was almost four times higher for those participants who had been informed about the complications, compared to those who had not been informed. ConclusionProper counselling is a main factor that affected the patients’ choice toward the mode of delivery. Proper pain management may encourage patients to choose TOLAC because fear of pain was a main reason that patients requested ERCS instead of TOLAC.

Uterine rupture over 11 years: A retrospective descriptive study.

Uterine rupture is a rare obstetric emergency, and the rate of rupture has increased over time with the rising rate of caesarean section (CS) and trial of labour after CS (TOLAC). To determine the prevalence, and maternal and neonatal complications associated with complete uterine rupture at a New Zealand (NZ) tertiary referral hospital over an 11-year period. This is a retrospective, observational study. Waikato Hospital records of patients with uterine rupture occurring between 2008 and 2018 were reviewed for risk factors, delivery outcomes, and maternal and neonatal complications. There were 32 patients with complete uterine rupture in 38182 births, conferring a prevalence of 8.4 per 10000 births (95% CI 5.9-11.8). Of the 29 cases occurring during labour, 83% of patients were multiparous, 59% previously had one or two CS;patients with an unscarred uterushad lower rates ofemergency CS and high rates of postpartum haemorrhage than patients with a scarred uterus. There were no maternal deaths although three patients required peripartum hysterectomy, 63% required blood transfusion and there were five (16%) perinatal deaths. The prevalence of uterine rupture in this NZ tertiary hospital is comparable to other developed countries. There was no maternal mortality but there was a 16% perinatal death rate. Patients with spontaneous labour and an unscarred uterus were not exempt from this rare complication. There is a need to manage labour judiciously in all patient groups and to maintain a high level of suspicion for uterine rupture.

The International Network of Obstetric Survey Systems study of uterine rupture: a descriptive multi-country population-based study.

International comparison of complete uterine rupture. Descriptive multi-country population-based study. International. International Network of Obstetric Survey Systems (INOSS). We merged individual data, collected prospectively in nine population-based studies, of women with complete uterine rupture, defined as complete disruption of the uterine muscle and the uterine serosa, regardless of symptoms and rupture of fetal membranes. Prevalence of complete uterine rupture, regional variation and correlation with rates of caesarean section (CS) and trial of labour after CS (TOLAC). Severe maternal and perinatal morbidity and mortality. We identified 864 complete uterine ruptures in 2 625 017 deliveries. Overall prevalence was 3.3 (95% CI 3.1-3.5) per 10 000 deliveries, 22 (95% CI 21-24) in women with and 0.6 (95% CI 0.5-0.7) in women without previous CS. Prevalence in women with previous CS was negatively correlated with previous CS rate (ρ = -0.917) and positively correlated with TOLAC rate of the background population (ρ = 0.600). Uterine rupture resulted in peripartum hysterectomy in 87 of 864 women (10%, 95% CI 8-12%) and in a perinatal death in 116 of 874 infants (13.3%, 95% CI 11.2-15.7) whose mother had uterine rupture. Overall rate of neonatal asphyxia was 28% in neonates who survived. Higher prevalence of complete uterine ruptures per TOLAC was observed in countries with low previous CS and high TOLAC rates. Rates of hysterectomy and perinatal death are about 10% following complete uterine rupture, but in women undergoing TOLAC the rates are extremely low (only 2.2 and 3.2 per 10 000 TOLACs, respectively.) TWEETABLE ABSTRACT: Prevalence of complete uterine rupture is higher in countries with low previous CS and high TOLAC rates.

Are There Differences between Women who Choose Elective Repeat Caesarean Versus Trial of Labour in St. John's, NL?

To compare the demographic and clinical characteristics between women who chose elective repeat Caesarean section (ERCS) versus trial of labour after Caesarean section (TOLAC) in St. John's, Newfoundland and Labrador (NL). We conducted a retrospective case control study of women with live singleton gestations delivering at term in St. John's, NL between January 1, 2001 and December 31, 2014. Inclusion criteria were women who had a previous single lower segment Caesarean section (LSCS). TOLAC, successful TOLAC, and VBAC rates were calculated. Demographic and clinical characteristics were compared between women who chose ERCS versus TOLAC. Univariate analyses and multiple logistic regression analyses were performed, and adjusted odds ratios (aOR) and 95% CIs were calculated. A total of 1579 women were included, of whom 160 (10.1%) chose TOLAC, with 107 resulting in successful VBAC (67% successful TOLAC rate). The overall VBAC rate was 6.8%. Women who chose ERCS compared with those who chose TOLAC were more likely to be obese (aOR 3.20, 95% CI 1.85-5.54, P < 0.001), less likely to have had GA at delivery greater than 40 weeks (aOR 0.13, 95% CI 0.08-0.21, P < 0.001), less likely to have had a previous vaginal delivery (aOR 0.40, 95% CI 0.20-0.80, P < 0.001), and less likely to have had the previous CS for breech presentation (aOR 0.51, 95% CI 0.33-0.80, P = 0.003). The overall TOLAC and VBAC rates in St. John's are low when compared with reported national rates. The successful TOLAC rate is within the expected range reported in the literature. Differences exist between women who chose ERCS compared with TOLAC.

Trial of Labour after Caesarean Section: A 5-Year Review

Background: Trial of labour after Caesarean section (TOLAC) refers to an attempt at vaginal delivery after a previous caesarean section. Outcome is influenced by a number of factors which are important in patient’s selection. Objectives: The aim of this study was to find out the incidence and feto-maternal outcome of the practice of Trial of labour after Caesarean section. Methodology: This is a retrospective study of cases of vaginal birth after Caesarean section Data were retrieved from the case notes of patients who attempted vaginal birth after Caesarean section from January 1, 2013 to December 31, 2017, a period of five years. Result: There were 10,669 deliveries, 3179 of which were through Caesarean section. This gave a Caesarean section rate of 29.8%. A total of 217 patients attempted vaginal birth after Caesarean section and 83 ended up as repeat Caesarean section (38.2%) while 138 (61.8%) had successful vaginal birth after Caesarean section. Patients with previous vaginal delivery, age range 25 - 29 years and interdelivery interval of greater than or equal to 2 years were more successful at achieving vaginal birth after Caesarean section. The leading indications for the repeat Caesarean section include cephalopelvic disproportion (45.8%), poor progress of labour (19.3%) and hypertensive disorders of pregnancy (8.4%). Conclusion: Vaginal birth after Caesarean section was successful in most of the parturients that attempted it in this study especially in patients within the age range of 25 - 29 years, those that have had previous vaginal delivery and with interdelivery interval of greater than or equal to 2 years.

Effect of excessive gestational weight gain on trial of labour after caesarean: A retrospective cohort study.

Counselling women for and managing birth after caesarean section are important. Research is needed on evaluation of antenatal factors that predict likelihood of successful trial of labour after caesarean section (TOLAC). To evaluate the effect of gestational weight gain on mode of delivery in women having TOLAC. A retrospective cohort study of eligible women who underwent TOLAC (January 2012 to July 2015) at a large urban hospital. Gestational weight gain was classified as 'excessive' or 'not excessive' based on calculated pre-pregnancy body mass index. Multivariable logistic regression analysis was performed to estimate the association of gestational weight gain and vaginal birth, adjusting for socio-demographic and pregnancy-related factors. Of 534 women, those who gained excessive weight were less likely to have a vaginal birth as women who did not (adjusted odds ratio (aOR) 0.48, 95% confidence interval (CI) 0.29-0.81)). Women with previous vaginal birth were more likely to have a vaginal birth (aOR 3.74, 95% CI 1.90-7.36), while women ≥35, women who had an epidural, and women who delivered at 40weeks, were less likely (aOR 0.58, 95% CI 0.35-0.97, aOR 0.12, 95% CI 0.07-0.22, and aOR 0.53, 95% CI 0.31-0.91, respectively). Gaining excessive weight in pregnancy is potentially modifiable, and can be incorporated into individual antenatal counselling, and into risk prediction models, to assist with informed decision making around planned mode of delivery in women with previous caesarean section. Future research could focus on interventions to reduce gestational weight gain in women planning TOLAC.

Vaginal birth after caesarean delivery in Chinese women and Western immigrants in Shanghai

Recent studies show a steep rise in caesarean sections in China. Most couples are now eligible to apply for a second child. This retrospective cohort study compares the prevalence of trial of labour and vaginal birth after caesarean section among Chinese and foreign women in Shanghai. In total, 135 of 368 women underwent trial of labour (36.68%), and of those, 77 (57.04%) had a vaginal birth. After inclusion in a multivariate model, factors associated with trial of labour were maternal age <35 years with an adjusted odds ratio of 2.58 (1.49–4.46), absence of a history of ≥3 abortions (2.22 (1.08–4.57)), and European citizenship (1.94 (1.05–3.59)). The prevalence of trial of labour and vaginal birth seems to mirror rates found in countries of origin, but despite a high rate of caesarean section, Chinese women had a higher rate of vaginal birth after caesarean section than North American and Australian women, in particular.Impact statementWhat is already known on this subject:Caesarean section (CS) rates are rising worldwide. Repeat CS contributes largely to these rates, although vaginal birth after CS (VBAC) rates varies widely between countries.What the results of this study add:North American and Australian women who deliver in Shanghai have low rates of attempted trial of labour after CS (TOLAC) and VBAC, with European women having the highest rate of TOLAC, followed by Chinese women.Implications for clinical practice and/or further research:These findings might reflect different levels of acceptance in line with respective national trends. Studies evaluating the influence of cultural norms on birth preferences after CS are needed. Further research is also needed to assess the overall acceptance of TOLAC in the context of the softening of the one-child policy in China.

Nationwide population-based cohort study of uterine rupture in Belgium: results from the Belgian Obstetric Surveillance System

ObjectivesWe aimed to assess the prevalence of uterine rupture in Belgium and to evaluate risk factors, management and outcomes for mother and child.DesignNationwide population-based prospective cohort study.SettingEmergency obstetric care. Participation...

A Review of Caesarean Sections Using the Ten-group Classification System (Robson Classification) in the Korle-Bu Teaching Hospital (KBTH), Accra, Ghana

Objectives: To determine the relative contributions of each of the 10 groups to overall caesarean section rate and identify modifiable groups for intervention to reduce caesarean section rates. Methods: Retrospective record review of the Robson Ten-Group Classification System (RTGCS) for caesarean sections from the statistical department of the Obstetrics and Gynaecology department. Results: The overall caesarean section rate is 46.9%. The contribution to the overall caesarean section rate in descending order is as follows: Group 5 (previous CS, single, cephalic, >37 weeks), group 2 (nulliparous, single cephalic, >37 weeks, induced or CS before labor), group 4 (multiparous (excluding previous CS), single cephalic, >37 weeks, induced or CS before labor), group 10 (all single cephalic, 37 weeks in spontaneous labor), group 7 (All multiparous breeches (including previous CS)), group 1 (Nulliparous, single cephalic, >37 weeks in spontaneous labor), group 6 (All nulliparous breeches), group 8 (All multiple pregnancies (including previous CS)), and group 9 (All abnormal lies (including previous CS). Conclusion: Groups 2, 4 and 5 were found to be the major contributors to the overall caesarean section rates and the modifiable factors for consideration in reducing caesarean section rates would be to improve the number of successful inductions of labour. This will decrease primary caesarean section rates, and decrease the numbers for trial of labour after caesarean section (TOLAC). TOLAC should be offered as per protocols and not left to individual obstetrician discretion.

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