Successful Vaginal Birth After Caesarean Section Research Articles

Predictors and Risks of Vaginal Birth after Cesarean Section: Insights from a Regional Referral Hospital in Uganda

Vaginal birth after cesarean section (VBAC) remains a topic of significant interest due to its potential benefits and associated risks. This retrospective cohort study aimed to identify predictors and risks associated with VBAC compared to elective repeat cesarean section (ERCD) among women delivering at Jinja Regional Referral Hospital in Uganda. We analyzed data from 384 women who had a previous cesareansection and delivered at the hospital between 2022 and 2023. Socio-demographic, obstetric, and medical characteristics were assessed for their association with successful VBAC using logistic regression. Risks of maternal morbidities between VBAC and ERCD groups were compared using Chi-square tests. The study found that BMI <35 kg/m², birth weight <3500g, spontaneous onset of labor, previous safe vaginal birth, and absence of diabetes mellitus were significant predictors of successful VBAC. Women undergoing TOLAC had a higher incidence of uterine rupture (p = 0.030), thromboembolism (p < 0.001), and blood transfusion requirement (p < 0.001) compared to ERCD. However, hysterectomy, hemorrhage, viscus injury, and pelvic floor trauma did not significantly differ between the two groups. Our findings highlight important predictors and risks associated with VBAC compared to ERCD in a regional referral hospital setting. Understanding these factors can aid clinicians in counseling women on their delivery options and managing potential risks associated with VBAC. Further research is warranted to explore strategies for optimizing VBAC outcomes while minimizing associated morbidities. Keywords: Maternal, Morbidity, Labor, Cesarean Section, Elective Repeat Cesarean Delivery, Jinja, Hospital

Cesarean Delivery Complicated by Peripartum Infection and Risk of Uterine Rupture During Subsequent Trial of Labor.

Background: Uterine rupture is a rare, but dangerous obstetric complication that can occur during trial of vaginal birth. Methods: The aim of this study was to evaluate the relationship between peripartum infection at the first caesarean delivery to uterine dehiscence or rupture at the subsequent delivery. We conducted a retrospective case-control study from March 2014 to October 2020 at a single academic medical center. The study group included women with a prior caesarean delivery and proven dehiscence or uterine rupture diagnosed during their subsequent delivery. The control group included women who went through a successful vaginal birth after cesarean section (VBAC) without evidence of dehiscence or uterine rupture. We compared the rate of peripartum infection during the first cesarean delivery (CD) and other relevant variables, between the two groups. Results: A total of 168 women were included, 71 with uterine rupture or dehiscence and 97 with successful VBAC as the control group. The rate of peripartum infection at the first caesarean delivery was significantly higher in the study group compared to the control group (22.2% vs. 8.2%, p = 0.013). Multivariate logistic regression analysis found that peripartum infection remained an independent risk factor for uterine rupture at the subsequent trial of labor after CD (95% confidence interval, p = 0.034). Conclusion: Peripartum infection in the first caesarean delivery, may be an independent risk-factor for uterine rupture in a subsequent delivery.

Maternal and Fetal Outcome in Patients with Vaginal Birth After Caesarean Delivery Comparison to and Elective Caesarean Section with Previous One LSCS

Introduction: Noteworthy improvements in maternal morbidity and mortality have been made possible by Caesarean section. However, vaginal birth after cesarean section (VBAC) is linked with better outcome in certain regards. The present study was aimed to study the maternal and fetal outcome in patients with VBAC and elective caesarean section with previous one LSCS.
 Methodology: Women with history of previous LSCS were divided in to two groups: Group 1- Women delivered by VBAD in the current pregnancy, and Group 2 - Women delivered by elective LSCS in the current pregnancy. Maternal and foetal outcome were assessed after delivery.
 Results: Total 90 women in each group were included in the study. The duration of active stage of labour was significantly higher in LSCS group compared VBAC group (p<0.05). Blood Transfusion and Premature rupture of membrane were not associated with any of the two groups. (p>0.05). The mean APGAR score at 1 min and 5 min were significantly better in VBAC group compared to in LSCS group (p<0.01). Mean stay of hospitalization was significantly higher in LSCS group (p<0.01).
 Conclusion: Better Bisho’s score has significantly more chances of successful VBAC. VBAC has better APGAR score at 1 min and at 5 min compared to LSCS group. Birth weight is not affected by the type of delivery after first caesarian delivery.

Vaginal Birth after Caesarean Section: A Study of 60 Patients with Spontaneous Onset of Labor Pain

Background: Most women with a singleton pregnancy of cephalic presentation at 37+ weeks or later who have had a single prior lower segment cesarean delivery, with or without a history of prior vaginal birth, are candidates for planned VBAC and may be offered it for a trial of VBAC. Objective: The objective of this study is to determine the outcome of vaginal birth after caesarean section (VBAC) in a tertiary care hospital in Sylhet. Methods: This prospective study took place between April 2022 and February 2023 and lasted for a total of eleven months. A total of sixty patients were hospitalized in the gynecology and obstetrics department at North East Medical College, all of whom had a history of either one or two previous cesarean sections and were experiencing labor pain. 43 of these patients had their deliveries through the vaginal route. The remainder of the patients had cesarean sections because of fetal distress, scar tenderness, and the patient's wish during 1st stage of labor. Results: The VBAC success rate in this study was 71.67%. Among the 43 patients, the highest number of patients, 51.2%, came from the age range of 28-37 years, followed by 21 patients (48.8%), who were in the age category of 18-27 years. The majority of the patients (24, 55.82%) were in their second pregnancy, with 10 (23.25%) in their third pregnancy and 9 (20.93%) in their more than third pregnancy. Among the 43 patients, 42 (97.7%) had a previous caesarean section, while the remaining 1 patient (2.3%) had two previous caesarean sections. Most patients (58.14%) were admitted to the hospital between 35 and 38 weeks of pregnancy. Among the participants, 97.7% had normal placenta size, 88.4% had average bleeding, 79.1% had clear liquor and 97.7% had no scar rapture. The study shows an extremely low level of complication in VBAC. Conclusion: This study identified that, the success rate of vaginal birth after one caesarean section is very high. An evidence-based systematic review suggested that planned VBAC is a safe and appropriate mode of delivery for the majority of pregnant women with a single previous lower-segment caesarean delivery.

Trend, prevalence and predictors of successful vaginal birth after caesarean section in Ethiopia: a systematic review and meta-analysis.

Vaginal birth after caesarean section (VBAC) is an alternative to a caesarean section (CS) in the absence of repeat or new indications for primary CS. There is a knowledge gap regarding the trend and successful VBAC in Ethiopia. Therefore this systematic review and meta-analysis aimed to assess the trend, pooled prevalence of successful VBAC and its predictors in Ethiopia. Electronic databases (SCOPUS, CINAHL, Embase, PubMed and Web of Science), Google Scholar and lists of references were used to search works of literature in Ethiopia. Stata version 14 was used for analysis and the odds ratios of the outcome variable were determined using the random effects model. Heterogeneity among the studies was assessed by computing values for I2 and p-values. Also, sensitivity analyses and funnel plots were done to assess the stability of pooled values to outliers and publication bias, respectively. A total of 12 studies with a sample size of 2080 were included in this study. The overall success rate of VBAC was 52% (95% confidence interval 42 to 65). Cervical dilatation ≥4cm at admission, having a prior successful vaginal delivery and VBAC were the predictors of successful VBAC. Meta-analyses and sensitivity analyses showed the stability of the pooled odds ratios and the funnel plots did not show publication bias. The pooled prevalence of successful VBAC was relatively low compared with existing evidence. However, the rate was increasing over the last 3decades, which implies it needs more strengthening and focus to decrease maternal morbidity and mortality by CS complications. Promoting VBAC by emphasizing factors favourable for its success during counselling mothers who previously delivered by CS to enhance the prevalence of VBAC.

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.

A successful vaginal birth after cesarean in a patient with uterine didelphys

Abstract Objectives With increasing rates of cesarean delivery across the United States, a trial of labor after cesarean (TOLAC) is a reasonable alternative for qualified candidates. Although Müllerian anomalies are associated with a variety of adverse pregnancy outcomes, there is little existing data regarding TOLAC in these patients. We present a case of a patient with a didelphys uterus who achieved a successful vaginal birth after cesarean section (VBAC) in the setting of labor augmentation. Case presentation Our patient is a 32-year-old G4P1021 (Gravida 4 Para 1,021–1 term delivery, 0 preterm deliveries, 2 abortions, 1 living offspring) who presented at 8 weeks of gestation with a known history of a didelphys uterus. Her obstetrical history was significant for a prior low-transverse cesarean section at term. All four of her pregnancies were located in the right uterine horn. At 39 weeks 3 days of gestation she presented in early labor and requested a TOLAC. She received an epidural, a cervical ripening balloon was placed, and she was started on pitocin. She pushed to deliver a viable infant. The patient’s postpartum course was uncomplicated, and she was discharged home on postpartum day two. Conclusions Müllerian anomalies are associated with several poor pregnancy outcomes including increased rates of PPROM, preterm delivery, FGR, and malpresentation necessitating a cesarean section. Our patient required augmentation of her labor but was ultimately able to achieve a successful VBAC with a healthy neonate. She represents an understudied population of patients with uterine anomalies who not only can have favorable pregnancy outcomes but may even be able to safely achieve a VBAC.

Uterine rupture

The increasing rate of elective and indicated caesarean sections worldwide has led to new pathologies and management challenges. The number of patients undergoing trial of labor after caesarean section (TOLAC) is also increasing. Three professional societies provide detailed guidelines based on scientific evidence for the management of patients attempting vaginal birth after caesarean section (VBAC). However, they do not provide any recommendations for the actual surgical steps to be followed to minimize the risks of uterine rupture (UR) during TOLAC. Uterine scar condition, intrapartum management and maternal health status correlate to uterine scar rupture risk and provide guidance for parturient TOLAC eligibility. TOLAC and vaginal delivery success rate as reported by the largest studies is between 60% and 77%. Uterine rupture is more prevalent in VBAC-2 patients (1.59%) in contrast to VBAC-1 (0.72%). Additionally, VBAC-2 patients have higher incidence of caesarean hysterectomy 0.56% vs. 0.19% for VBAC-1. The chances of successful VBAC increase when the interpregnancy/interdelivery interval is less than 6.3 years and less than 24 months, respectively. No difference was detected between the techniques of uterine incision closure of the previous CS and TOLAC results, although closure of the CS uterine incision in 2 layers seems to be practiced more widely. Niche or isthmocele presents another complication of CS. Secondary infertility due to niche, will eventually direct to hysteroscopic or laparoscopic repair, depending on the residual myometrial thickness (RMT) as measured by US scan. When RMT is below 3 mm or 2.5 mm surgery can be performed, to prevent any spontaneous UR in case of pregnancy. Monitoring by US scanning of hysterotomy scar after myomectomy can detect hematoma. In patients with severe postoperative pain but hemodynamically stable follow up by US scan examination can direct the management decision. In those patients with active bleeding and deterioration of hysterotomy scar edema will be an indication to surgery. There is no firm evidence regarding which type of thread, knotting or sequence of suturing is more favorable to reduce the risk of UR after VBAC or hysterotomy after myomectomy.

Validation of updated antenatal vaginal birth after caesarean section prediction model without race and ethnicity in Australia.

The Grobman antenatal nomogram to predict likelihood of successful vaginal birth after caesarean section (VBAC) has been validated in multiple institutions. However, due to concerns regarding inclusion of ethnicity, a new nomogram has been developed. The aim was to evaluate the efficacy of the updated Grobman nomogram without ethnicity in a regional hospital in Australia. This was a retrospective cohort study of women electing to have a VBAC at a regional hospital over a nine-year period. Maternal demographics and obstetric outcomes were collected. Women were assigned a predicted likelihood of successful VBAC using the updated Grobman nomogram, with variables such as age, pre-pregnancy weight, height and arrest disorder as indications for previous caesarean birth, previous vaginal birth, previous VBAC and treated chronic hypertension. The predicted likelihood of successful VBAC was compared with actual successful VBAC rates. A total of 541 women attempted VBAC with a VBAC success rate of 74.3% (402/541). The nomogram demonstrated good fit, with a receiver operating curve area under the curve of 0.707 (95% confidence interval 0.659-0.755). Using a cut-off value of 0.5, the success rate of classification with this model was 74.3%. On comparing each predicted decile, the nomogram performed poorly in those predicted to have a <40% chance of successful VBAC. This study confirms the use of the updated Grobman nomogram without ethnicity, alongside usual counselling, to provide individualised advice for informed decision-making. However, clinicians should be mindful of the limitation of poor accuracy in women with a low predicted probability of VBAC.

Risk factor analysis in women who underwent trial of labor after cesarean section: a multicenter study in Germany

Objective:Rising caesarean delivery (CD) rates throughout the world are accompanied with high rates of severe maternal complications. The aim of the present study was to analyze the outcome of trial of labor after caesarean section (TOLAC) in a Western population and identify factors associated with the success of vaginal birth after caesarean section (VBAC).Material and Methods:A retrospective study was performed at two large obstetric departments in Germany from 2008 to 2018. Women with singleton pregnancies, a history of only one previous CD with a low transverse incision, a viable fetus in cephalic presentation, and gestational age >32 weeks were included in the study. The characteristics and outcome of successful VBAC and failed TOLAC were compared. A subgroup analysis addressed gestational age, interpregnancy interval, fetal macrosomia, body mass index, and maternal age.Results:Of 1,546 patients, 62.3% achieved VBAC while 37.7% had a secondary CD. Independent factors associated with the success of TOLAC were a history of vaginal birth in previous pregnancies (p<0.001) and the use of oxytocin (p<0.001), whereas preterm birth between gestational week 32 and 37 signified a higher risk of failed TOLAC (p=0.04). The success of VBAC did not differ significantly for patients older than 40 years of age, those with a shorter interpregnancy interval than 12 months, and fetal macrosomia with birth weight exceeding 4000 grams. Maternal and neonatal outcomes were poorer in women with failed TOLAC.Conclusion:Nearly two thirds of women with a history of CD achieve VBAC in Germany. Previous vaginal birth and the augmentation of labor with oxytocin are positively associated with the achievement of VBAC and no major perinatal complications. The decision to have a TOLAC should be encouraged in the majority of patients. Further studies are needed to evaluate the feasibility of TOLAC in preterm delivery.

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

Aims &amp; Objectives: To find out the predictors of spontaneous term vaginal birth after a previous one lower segment caesarean delivery. Materials &amp; Methods: A prospective study was conducted in the Department of Obstetrics &amp; 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.

Labor characteristics and intrapartum interventions in women with vaginal birth after cesarean section

BackgroundWith the development of China’s two-child-policy, vaginal birth after cesarean section (VBAC) has aroused public concern. It is important to understand the labour characteristics and intrapartum management of women attempting VBAC to enhance the rates of successful VBAC. The purpose of our research was to investigate the differences in the characteristics of labor, intervention measures and perinatal outcomes between women who had a VBAC and primiparas or multiparas not undergoing VBAC, providing clinical references of intrapartum management for women who are planning a VBAC.Material and methodsThis observational retrospective study enrolled all women who laboured spontaneously and who had a VBAC (n = 139) at the Second Affiliated Hospital of Wenzhou Medical University in China between 2016 and 2019. They were allocated into VBAC group A (the previous cesarean section was performed before dilation of the cervix) and VBAC group B (the previous cesarean section was performed after dilation of the cervix). The primipara control group included 149 primiparae, and the multipara control group included 155 multiparae with second vaginal birth. Durations of labor, intervention measures and perinatal outcomes were compared among the groups.ResultsThe durations of labor, intrapartum interventions and maternal and neonatal outcomes in VBAC group A were similar to those of the VBAC group B. However, all women who had a VBAC and those in VBAC group A had shorter first, second and the total stages of labor than primiparae. All women with VBAC and those in VBAC group B had longer second stage of labor, but shorter third stage of labor than multiparae. Oxytocin, labor analgesia and artificial rupture of membranes were administered less often in women with VBAC than in primiparae, while phloroglucinol was administered more often in women with VBAC than in multiparae. Women who had a VBAC were more likely to receive episiotomy and had higher incidences of postpartum hemorrhage than primipara and multipara women.ConclusionsLabor characteristics, intrapartum interventions and perinatal outcomes in women who had a VBAC with cervical dilation were similar to those in women who had a VBAC without cervical dilation before the previous cesarean section, but differed significantly from those of multiparae and primiparae who did not undergo VBAC.

Outcome of Vaginal Birth after Caesarean Section at a Tertiary Health Facility, Southern Nigeria

Background: Caesarean section rate has been on the increase in the past few years. Previous caesarean sections are a major indication for caesarean sections. The risks associated with repeat caesarean sections have brought about the need to adopt vaginal birth after caesarean section (VBAC) as the preferred mode of delivery in a previously scarred uterus. Aims and Objectives: To determine the pregnancy outcome and complications of vaginal birth after caesarean section at the University of Port Harcourt Teaching Hospital. Materials and Methods: This was a retrospective descriptive study of 121 women with one previous caesarean section who presented at the labour ward of the University of Port Harcourt Teaching Hospital between January 1, 2010, and December 31, 2019. Data was obtained from the case notes, ward, and theatre registers, encoded into a spreadsheet, and analyzed using SPSS 22.0. The results are presented as means, rates and proportions. Associations between variables were assessed using students t-test and Pearson’s correlation. Statistical significance was considered at P&lt;0.05. Results: There were 20,661 deliveries during the period under review. Of these, 175 had vaginal birth after caesarean section (VBAC). However, only 121 case notes were available for analysis. About one third, 44 (36.36%) of the women had previous successful VBAC and 5 (4.13%) had augmentation of labour. Perineal laceration was the most common complication 38 (31.4%). Majority of the babies 103 (85%) had APGAR scores &gt; 7 in the first minute, while 10 (8.55%) were admitted in the Special Care Baby Unit. Maternal age, socioeconomic status, gestational age at delivery and birth weight were not significantly associated with the outcome of VBAC. Conclusion: Vaginal Birth after Caesarean Section is safe and should be recommended in carefully selected women with previous caesarean section, to reduce the morbidities associated with repeat caesarean sections.

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).

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.

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.

The Development of a Prediction Model for Vaginal Birth After Cesarean Section (VBAC) [34P

INTRODUCTION: Pregnant women who have had a previous cesarean section face the decision to either undergo a repeat elective cesarean or to attempt vaginal birth after cesarean (VBAC). The goal of this project was to determine the factors that predict success of VBAC in women with one prior cesarean section in the population of British Columbia, Canada. METHODS: Data were drawn from the British Columbia Perinatal Data Registry. We performed a retrospective analysis of 8291 cephalic term singleton planned vaginal births in British Columbia to women with a previous cesarean. Using block multivariate logistic regression, we analyzed the variables, both modifiable and non-modifiable, most predictive of successful VBAC. A result was considered statistically significant if its p value was &lt;.05. RESULTS: Of the 8291 planned VBAC births, 5960 were successful, while 2331 resulted in cesarean deliveries. Predictive variables were: maternal age, height and BMI, whether or not she had a vaginal birth within 2 years of the planned VBAC, whether she had a recurrent indication for the prior cesarean, whether she was administered oxytocin or prostaglandins for labor augmentation or induction, whether she was given an epidural, and the size of hospital in which she gave birth. CONCLUSION: A prediction model, incorporating eight variables has been developed. This model can inform shared decision-making and guide individualized counselling for eligible women on the chance of VBAC success. We hope that this prediction model will contribute to the literature and ultimately lower the probability of complications and adverse outcomes in childbirth.

Frequency of uterine rupture after one successful vaginal birth after cesarean section (VBAC).

Objectives: To determine the frequency of uterine rupture after one successful vaginal birth after caesarean section. Study Design: Cross Sectional Study. Setting: Department of Obstetrics and Gynecology of Nishtar Hospital Multan. Period: From12-May-2017 to 11-May-2018. Material &amp; Methods: Total number of 135 patients of 16-45 years with singleton pregnancies were admitted for 2nd Vagina Birth after cesarean Section at gestational age ≥ 28 weeks of gestation. Data in shape of parity, gestational age and BMI was taken. These patients were assessed for frequency of uterine rupture after one successful vaginal birth after caesarean section. Data was analyzed with statistical analysis program (SPSS version 21). Frequency and percentage was calculated for qualitative variables like parity and uterine rupture. Mean ± SD was calculated for quantitative variables like age, BMI and gestational age. Results: Mean age of patients was 29.88+5.34 years. Mean body mass index (BMI) of study patients was 25.17+4.88 kg/m2. Mean gestational age at the time of delivery was 39.01+2.54 weeks. Uterine rupture after vaginal birth occurred in 2 (1.48%) patients. There was no association of gestational age, parity and gestational age with the frequency of uterine rupture. Conclusion: Women with prior successful VBAC are at low risk of maternal and neonatal complications during subsequent trail of VBAC with lower risk of uterine rupture and perinatal complications.

Rates of vaginal birth after caesarean section: What chance do obese women have?

For women considering vaginal birth after caesarean section (VBAC), obesity has been associated with a lower rate of vaginal birth and a higher rate of uterine rupture. To enhance antenatal counselling, this study aimed to evaluate the success rates of morbidly obese women undergoing a trial of labour (TOL). A retrospective analysis was performed of women who birthed at our hospital who had previously had one caesarean section. Routinely collected data were reviewed for mode of birth for women who underwent a TOL. A number of maternal and neonatal outcomes were also gathered. The data were analysed according to those women with a body mass index (BMI) equal to or above 40, compared to those women with a BMI below 40. From 2011 to 2018, 2097 women gave birth at our hospital and had a caesarean section for a prior pregnancy. Of these women, 1234 (58.9%) had an elective caesarean section and 863 (41.1%) underwent a TOL. Of the women undertaking a TOL, 73.1% gave birth vaginally. Women with a BMI equal to or greater than 40 were less likely to have a successful VBAC compared to women with a BMI less than 40 (58.9% vs 74.1%, P=0.013). Only 50% of women with a BMI equal to or greater than 40 had a successful VBAC if they had not previously had a vaginal birth. Women with a BMI over 40 had lower rates of successful VBAC. Rates were even lower for those who had not had a prior vaginal birth.