History Of Vaginal Delivery Research Articles

Predictive Model for Successful Induction of Labor in Early Onset Pre-Eclampsia With Severe Features [24R

INTRODUCTION: Hypertensive diseases of pregnancy complicate approximately 10% of pregnancies. Optimal timing and mode of delivery is unclear for pregnancies complicated by early onset pre-eclampsia with severe features (<34 weeks). This study aims to identify characteristics associated with the patient, fetus, and pregnancy that may affect the likelihood of successful vaginal delivery, which may guide future counseling of these patients. METHODS: This is a retrospective cohort study of women at a large tertiary medical center from 2012-2016. It included a total of 159 patients who delivered at <34 weeks with pregnancies complicated by pre-eclampsia with severe features. Risk factors for failed induction of labor were compared using various statistical methods. We developed and validated a predictive model using a step-wise procedure to calculate a patient's risk for having a failed induction of labor. RESULTS: Of 159 patients who underwent induction of labor, 77 resulted in successful vaginal deliveries. History of prior vaginal delivery, history of preterm labor, and increased parity, were associated with successful induction of labor. Conversely, elevated umbilical artery dopplers, earlier gestational age, lower bishop score, and current smoking were associated with higher rates of cesarean delivery. CONCLUSION: Overall, 48.4% of patients delivered vaginally following induction of labor in the setting of early onset pre-eclampsia with severe features. We developed a predictive model to classify patients with regards to risk for cesarean section, which included the following variables: pregnancy history, bishop score, age, smoking status, obesity. Further research can better elucidate the impact of different characteristics in predicting mode of delivery.

Effect of mode of delivery on female sexual function: A cross-sectional study.

A growing body of evidence has suggested a significant impact of mode of delivery on female sexual function. In the present study, we aimed to investigate the effect of mode of delivery on postpartum sexual function. We conducted a cross-sectional study on 684 women during their first year after their first delivery. The sexual function of the included women was assessed using the Arabic version of the Female Sexual Function Index (FSFI). Data analysis was carried out using SPSS version 22 for Microsoft Windows. The present study included 684 primiparous women, in which 320 women had a history of vaginal delivery (VD0 and 364 women had a history of Cesarean section (CS). In terms of FSFI items, women with a history of CS had statistically significant higher FSFI total score than women with VD (31.34 ± 3.8 vs 30.23 ± 3.6, respectively; P < 0.001). Moreover, patients with more than 6 months since birth had a statistically significant higher total FSFI score than patients with less than 6 months since birth (30.97 ± 3.5 vs 29.97 ± 3.5, respectively; P < 0.001). However, the difference was clinically subtle. In addition, women who breastfed their babies had statistically significant lower total FSFI score than women who used artificial methods of lactation (29.61 ± 4.2 vs 30.27 ± 3.3, respectively; P < 0.001). In conclusion, the present study showed that the mode of delivery was not clinically associated with clinical impairment in sexual function within 1 year after delivery, despite the statistically significant difference. It is recommended that the decision to perform CS should not rely on the fear of the risk of postpartum sexual dysfunction.

Does perineal body thickness affect faecal incontinence in multiparous patients?

Background. Obstetric trauma is the most common cause of faecal incontinence in multiparous women. The literature has shown that women with obstetric trauma to the anal sphincter have decreased perineal body thickness (PBT). Objective. To determine the role of PBT in the assessment of this type of faecal incontinence in multiparous patients. Methods. Forty-four women with faecal incontinence, and 36 asymptomatic women who had had two or more previous deliveries, were investigated with endoanal ultrasonography from January to December 2016. The patients were divided into three groups on the basis of PBT: 12 mm. The degree of faecal incontinence was measured using the Wexner faecal incontinence score. Sphincter angle defect was separately measured for each patient. Results. The mean (standard error) age of all of our 80 patients was 46.9 (1.3) years (range 26 - 77 years), and the mean PBT in incontinent patients was 8.78 (2.84) mm, and 12.65 (16.76) mm in asymptomatic subjects ( p <0.001). The mean Wexner score was 8.6 (range 2 - 20) in incontinent patients. External anal sphincter defect angles were negatively correlated with PBT ( p =0.045). For 89% of the patients, there was a history of vaginal delivery, and 62.5% had undergone one or more prior episiotomies during delivery. A PBT <10 mm was associated with sphincter defect in most incontinent patients. Conclusion. PBT plays a significantly important role in faecal incontinence, so it is recommended that it should be one of the factors involved in anal incontinency evaluations.

An exploratory study into social and healthcare variables of maternal mortality: a case-control study.

Background Regarding the important role the mothers' health plays in shaping nations' well-being, this study endeavored to explore the main social and healthcare factors related to maternal mortality. Methods In this case-control study, data (viz., all maternal mortalities) were gathered from the national maternal mortality surveillance system. Likewise, control data (viz., alive mothers) were obtained from mother health records in 22 health centers located in 21 cities of Isfahan, Iran. The data were related to the years 2001-2016. Case and control groups were matched according to year of delivery, mother's age at delivery time and city of residence. Results Analysis of the gathered data revealed that during the years 2001-2016, 171 maternal mortalities occurred in Isfahan. In view of that, 523 mothers were selected as the control group. Most of the mothers attended high school (36%), were housewives (64%), delivered by cesarean section (59%) and suffered from different kinds of proximate medical causes (55%). The logistic regression results showed that being an immigrant, having a history of proximate medical cause, vaginal delivery and illiteracy raised the odds ratios (ORs) of maternal mortality up to 5.87, 4.41, 2.28 and 1.84 times, respectively. In contrast, using public antenatal care and planned pregnancy have had a protective, significant effect on maternal mortality (ORs <1). Conclusion The results suggested that in addition to social factors including immigrant status and low level of education which led to the increase of maternal mortality, healthcare factors including proximate medical causes, delivery method and antenatal care seem to be essential in tackling the issue of maternal mortality.

Exploring the Effect of Mindfulness-Based Stress Reduction on Childbirth Fear Among Single-Child Mothers in the City of Kerman, Iran (2017): A Clinical Trial Study

Background: Painful memories from previous childbirth can linger and impose negative effects on the mind of a woman throughout her life. They may also create a permanent fear of delivery and turn into a barrier to future pregnancies. Objectives: The aim of this study was to investigate the impact of mindfulness-based stress reduction (MBSR) on the fear of delivery in single-child mothers with a history of vaginal delivery in the city of Kerman, Iran. Methods: This is an experimental, interventional study with pretest-posttest design and a control group. The statistical population encompassed all single-child women in the city of Kerman who had had childbirth at least six years earlier and had not become pregnant due to childbirth fear. The sample consisted of 41 participants, 20 of whom received the MBSR group training in eight sessions (each lasting for 90 minutes). Fear of childbirth was evaluated before and after the intervention using Harman's Childbirth Attitudes Questionnaire (CAQ). Data were analyzed by SPSS 22 using a paired t test, covariance, independent t test, and chi-square test. Results: The mean scores of childbirth fear in the intervention and control groups were 37.58 ± 5.9 and 33.19 ± 6.55, respectively, before implementing the program and 36.25 ± 5.40 and 33.00 ± 6.47 after that. The level of fear after the intervention was significantly higher in the experimental group than in the control group (P < 0.001). Besides, the greatest effects of the instructions were observed on the fear of painful injections, loneliness, and worry over the hospital environment. Conclusions: Group training of MBSR is helpful in reducing childbirth fear, and thus it can be deployed as a procedure for encouraging childbearing in women who are not willing to re-experience pregnancy due to the fear of delivery.

Comparison of topical lidocaine spray with forced coughing in pain relief during colposcopic biopsy procedure: a randomised trial

Our objective was to compare the effectiveness of local lidocaine spray (LS) compared to forced coughing (FC) for relieving the pain during colposcopically guided cervical biopsies (CGBs). The study was a randomised study, which included patients with abnormal cervical cytologic results requiring a colposcopic biopsy procedure. The patients were randomly assigned to either the 10% LS or the FC groups before the biopsy procedure. As a primary outcome, the pain was assessed by using a 10 cm visual analogue scale at the different steps during the procedure. Forty-four and 42 patients had CGBs using LS and FC, respectively. The age, parity, body mass index, history of previous curettage and vaginal delivery, smoking status and the number of biopsies were similar in both groups. The mean ± SD pain scores after the cervical biopsy were 3.25 ± 1.4 and 4.4 ± 1.3 in the LS and FC groups, respectively (p< .05). The operative time was longer in the LS than in the FC group (7.6 ± 1.4 vs. 5.2 ± 0.8, p: .004). No complication or adverse effect was observed in both groups. The present study showed that LS use can be recommended for pain relief during colposcopically directed cervical biopsy procedure with a superiority to the FC in the terms of pain and absence of any adverse reactions.Impact StatementWhat is already known on this subject? A colposcopic-guided cervical biopsy is a painful procedure and different techniques have been proposed to relieve this pain with conflicting results. Studies have demonstrated that a forced coughing is a good and easy method for relieving pain with some disadvantages. Local lidocaine spray (LS) is another option for pain relief during the biopsy procedure. However, no randomised study has compared these two methods yet.What the results of this study add? The results from this randomised study suggest that LS has superiority in terms of pain relief during the colposcopic biopsy procedure and has no adverse reactions.What the implications are of these findings for clinical practice and/or further research? The evidence from different studies showed some conflicting results regarding the pain relief methods during the colposcopic biopsy procedure. The local LS can be used in this procedure in routine clinical practice. However, further studies with larger samples and comparison of different methods are needed.Trial registration: ClinicalTrials.gov identifier: NCT03100565.

Use of amnion graft and surgicel in vaginoplasty for secondary vaginal atresia: A case report

Vaginal atresia can be congenital or acquired. The tissue is virgin in primary vaginal atresia or agenesis, so various methods have been used with successful outcomes. On the other hand, one can expect a lot of fibrosed tissue in secondary atresia. There is no elaborate literature on secondary vaginal atresia. There is also no standard treatment for both the types of vaginal atresia. The use of amnion graft and surgicel in vaginoplasty for secondary atresia is one of our experiences with best results. We report a case of a 22-year-old primipara who presented with dyspareunia and cyclical lower abdominal pain for the past 4 months. She had a history of traumatic vaginal delivery 3 months prior to presentation. On examination, she was diagnosed with secondary vaginal atresia. We managed her by vaginoplasty with amnion grafting and surgicel, followed by regular dilatation with soft vaginal mould for the next 6 weeks. Our patient is doing well with normal coital function on follow-up.

Cyclopia: A Rare Congenital Malformation

Cyclopia is a rare and lethal congenital anomaly of the forebrain system, resulting from incomplete cleavage of prosencephalon into right and left hemispheres occurring between the 18th and the 28th day of gestation. Approximately 1.05 in 100,000 births are identified as infants with cyclopia, including stillbirths. Many teratogenic factors are identified as the causative factors for this anomaly which include irregular cholesterol biosynthesis, radiation exposure, viruses, alcohol intake and maternal diabetes. Many authors also suggest genetic etiology of this illness. We report a case of 35 year old lady G7P6L5 with previous history of normal vaginal delivery who presented to us in second stage of labor. She delivered a male baby with a large head, a median single eye and absent nose with intact mouth. The baby died soon after the birth. This case is presented because of its rarity. Early ultrasound diagnostics and proper management of this anomaly must be emphasized most strongly to prevent complication associated with this condition.

Cesarean sections. Associated factors and frequency at King Abdulaziz Medical City in the Central Region of the Kingdom of Saudi Arabia.

Objectives:To study the associated factors for cesarean section (C-section) in a sample of pregnant women and to estimate its frequency at King Abdulaziz Medical City in Riyadh, Kingdom of Saudi Arabia (KAMC-R).Methods:We studied 364 pregnant women who attended the Gynecology and Obstetrics Clinic at KAMC-R between March and June 2017.Results:Our 3-month study had higher rates of C-sections: women with older maternal age; (adjusted risk ratio [aRR]=1.08, p=0.001), lack of education (aRR=1.39, p=0.022), no personal history of vaginal delivery (aRR=1.85, p=0.001), undergoing C-section due to medical indications (aRR=2.28, p=0.001), and willing to repeat a C-section in the absence of medical indications (aRR=1.49, p=0.006). Cesarean section occurred in 27% of the total deliveries in 2016.Conclusion:Cesarean section are very frequent and prevalent in our center, and may be increasing. The frequency of C-sections was significantly higher for women of older maternal age, little education, no personal history of vaginal delivery, undergoing C-sections due to medical indications, and those willing to repeat a C-section in the absence of medical indications.

History of Vaginal Delivery Is an Independent Risk Factor for Diverticular Disease

History of Vaginal Delivery Is an Independent Risk Factor for Diverticular Disease

Efficiency of the Foley catheter versus the double balloon catheter during the induction of second trimester pregnancy terminations: a randomized controlled trial.

To compare induction-to-delivery intervals of Foley catheters and double balloon catheters in second trimester pregnancy terminations. This randomized parallel study was conducted on women who underwent second trimester terminations between December 2016 and December 2017. Pregnant women in the second trimester with a Bishop score < 6 were included in the study. Participants were randomized into two groups, the first being the Foley catheter group and the second being the double balloon catheter group. The time frames from insertion of catheters to the delivery were recorded in each group. A multiple regression analysis was carried out to examine the contribution of factors to the induction-to-delivery interval. A survival analysis was conducted to compare the Foley method and the double balloon method. A total of 91 pregnant women were included in the final analysis. The induction-to-delivery interval was shorter in the Foley catheter group than in the double balloon catheter group (38h 54min ± 21h 6min versus 58h 17min ± 25h 56min). We also found that women with intrauterine fetal death (IUFD) had a shorter time to delivery compared to women with live fetuses (39h 12min ± 18h 46min vs 51h 30min ± 26h 42min, p = 0.04). Women with a history of vaginal delivery also had a shorter induction-to-delivery time compared to women who never delivered vaginally before (38h 12min ± 17h 42min vs 53h 54min ± 27h 18min, p = 0.004). In the multiple regression analysis, the most significant contributor to the induction-to-delivery time was the method used for induction of labor and followed by other factors including the viability of the fetus (live/IUFD), history of vaginal delivery and PPROM. The survival analysis showed that the induction-to-delivery interval was significantly shorter in the Foley catheter group than in the double balloon catheter group (HR 2.51, 95% CI 1.57-4.00, p = 0.001). During the termination of second trimester pregnancies time from induction of labor to delivery is shorter with the Foley catheter compared to double balloon catheter.

Obstetric Risk Factors and Anal Incontinence among Women with Previous History of Vaginal Delivery

Objective: To investigate the obstetric risk factors of the analincontinence in mothers with previous history of vaginaldelivery.Methods: The was a case-control study conducted in the Obstetricsand Gynecology Department of Dr.Wahidin Sudirohusodo Hospital,Faculty of Medicine, Universitas Hasanuddin, Makassar, during theperiod of February 2015 through January 2016. The researchinstruments were used to evaluate obstetric risk factors and theanal incontinence was the self-administered questionnaire and FecalIncontinence Severity Index. The data were analyzed statisticallyusing the Chi-square test with the significant value of p&lt;0.05.Results: A total of 300 subjects were recruited in this study. Theresearch results indicated that the parity of  3, the assisted vaginaldelivery history (vacuum extraction), and the prolong secondstage of labor had a significant correlation with the anal incontinencewith p value=0.026, OR (95% CI) = 1.8 (1.07-3.03), p=0.018with OR (95% CI) =3.65 (1.2-10.7) and p=0.006 with OR (95% CI)= 2.9 (1.2-6.7).The history of episiotomy and the delivery of thebaby  4000 gram had no correlation with the anal incontinence.Conclusion: Parity, vacuum delivery and prolong second stage oflabor have an association with anal incontinence among womenwho has history of vaginal delivery.Keywords: anal incontinence, obstetric risk factors, vaginal delivery

Vaginal birth after previous cesarean section in low-resource countries: healthcare chain and materno-fetal follow-up

Le taux d'utérus cicatriciel, facteur de risque établi de la morbidité obstétricale augmente à travers le monde. Dans les pays en développement, les ruptures sur utérus non cicatriciel peuvent constituer 87,4% des cas. Sa prise en charge demeure ainsi une problématique de l'obstétrique moderne, notamment dans ces pays. L'objectif était de décrire le circuit de prise en charge et le devenir materno-fœtal des accouchées porteuses d'utérus cicatriciel dans trois hôpitaux universitaires de la ville de Yaoundé pour un état des lieux de la problématique de la prise en charge de cette morbidité grave dans les pays à faible ressources à l'aube des Objectifs pour le Développement Durable. Il s'agissait d'une étude descriptive, transversale avec collecte prospective des données, sur une période de six mois en 2014. Etaient inclues les accouchées consentantes, porteuse d'utérus cicatriciel, ayant accouché à un âge gestationnel supérieur ou égal à 28 semaines d'aménorrhée révolue. L'échantillonnage était consécutif et exhaustif. Chi carré a été le test utilisé statistiquement, P≤ 0,05 étant le seuil de fiabilité. Nous avons recruté 252 cas d'utérus cicatriciel, soit une fréquence de 8% (252/3145) pendant la période d'étude.30% avaient des CPN réalisées par un personnel inadéquat dans une structure sanitaire non appropriée,25% étaient référées avec complications pendant le travail après une première admission dans une formation sanitaire inadéquate, dont les 6 cas de ruptures utérines et 7 fœtus décédés avant l'admission.39% avaient une indication de césarienne/laparotomie dès l'admission, le taux d'accouchement par voie basse était de 23% , l'épreuve utérine était indiquée chez 30%, avec un taux de réussite de 76,3% .L'accouchement par voie basse était corrélé à la parité, les antécédents d'accouchement par voie basse , la macrosomie fœtale et inversement corrélé au nombre de cicatrices .Le nombre de décès maternel était nul et l'accouchement par césarienne était corrélé aux morbidités materno-fœtales. La mauvaise qualité des CPN et de la prise en charge de l'accouchement demeurent les principaux déterminants de la problématique de l'accouchement sur utérus cicatriciel dans notre milieu. La mise en place d'un système facilitant l'accessibilité des femmes enceintes porteuses d'utérus cicatriciel aux prestataires/formations sanitaires adéquats permettrait d'améliorer le pronostic des accouchées porteuses d'utérus cicatriciel.

Su1615 - History of Vaginal Delivery Independently Predicts Increased Risk of Dyssynergic Defecation in Women with Constipation

Su1615 - History of Vaginal Delivery Independently Predicts Increased Risk of Dyssynergic Defecation in Women with Constipation

Giant Ovarian Mucinous Cystadenoma Complicating Term Pregnancy

Huge ovarian cyst are found in less than 1% of all ovarian cyst in pregnancy and are associated with poor feto-maternal outcome. A 28 years old G2P1 with history of normal vaginal delivery 3 years back was referred from local health post with complains of intermittent pain abdomen at 29 weeks. Her scan showed huge ovarian cyst of 18.9×17.6 cm with multiple thick septation. Woman was conservatively managed till term and elective surgery was planned however she presented in labour with breech presentation at 39 weeks and 4days. Emergency lower segment caesarian section along with left sided salpingo-oophorectomy was done along with delivery of 2.5 kg healthy female baby. Histopathology was suggestive of mucinous cystadenoma of ovary. Although antepartum removal of ovarian cyst has been recommended to ensure good pregnancy outcome, expectant management and timed intervention can be adopted for pregnancy with huge ovarian cysts. Keywords: mucinous cystadenoma; ovarian cyst; pregnancy.

Long-Term Outcomes After Overlapping Sphincteroplasty for Cloacal-Like Deformities.

The aim of this study was to report subjective, long-term outcomes and describe patient demographics, presenting symptoms, perioperative management, and complications after overlapping sphincteroplasty repair for chronic fourth-degree lacerations (cloacal-like deformities). In this retrospective study, hospital records were reviewed for women who underwent overlapping anal sphincteroplasty for a cloacal-like deformity of the perineum at a single institution from 1996 to 2013. Details including patient demographics, presenting symptoms, perioperative management, and complications were abstracted from the medical record. As a follow-up, subjects were contacted by telephone and were administered the validated Modified Manchester Health Questionnaire to assess anal continence status and anal incontinence-related quality of life since the time of surgery. Of 57 women who underwent an anal sphincteroplasty within the study period, 29 met inclusion criteria. Median parity was 3 (range, 1-7) and 24.5% reported a history of forceps or vacuum-assisted vaginal delivery. Presenting symptoms included fecal incontinence (58.6%), flatal incontinence (41%), sexual dysfunction (20.7%), and poor body self-image (3.4%). Thirteen (45%) women could be contacted by telephone and all agreed to participate. Overall, 46.2% of the 13 women who completed the Modified Manchester Health Questionnaire reported some form anal of incontinence, whereas 53.8% reported complete continence at a mean follow-up of 7.0 ± 3.6 years. Perioperative morbidity was uncommon, and postoperative antibiotics were used in 75.9% of cases for a median duration of 8.8 ± 3.3 days. Perioperative morbidity after overlapping sphincteroplasty for cloacal-like deformities after obstetrical injury is rare. Although long-term complete anal continence may be difficult to achieve in all cases, good quality of life measures and low symptom severity were noted at a mean interval of 7 years after surgery.

Is Striae Gravidarum related to Cesarean Scar and Peritoneal Adhesions?

Objective:To evaluate the relationship between striae gravidarum (SG) score and abdominal scar characteristics together with intraperitoneal adhesion (IPA) grades of patients who were hospitalized for second cesarean delivery.Methods:A total of 145 consecutive women undergoing scheduled cesarean section (CS) in a tertiary level maternity hospital between November 2013 and January 2014 were included in the study. All women had transverse suprapubic skin incision due to the previous CS and none of them had a history of vaginal delivery. Patients were classified according to the SG status, as women with no SG: Group-1(n=53), mild SG: Group-2(n=27) and severe SG: Group 3(n=65). Groups were compared between themselves with regard to various sociodemographic properties, cesarean scar characteristics and IPA scores.Results:No significant difference in the length, width and color of the scar was detected among groups. While flat scar was the most prominent form of scar, the elevated scar was significantly more frequent in Group-1 compared to other groups (p=0.009). IPA grades were 0 or 1 in 77.3% of Group-1, 81.3% of Group-2 and 76% of Group-3. There was no significant difference in IPA scores between groups (p=0.884). After combining CS scar characteristics (flat, depressed and elevated) and SG status [SG (+) or SG (-)], we found no significant difference between the groups in terms of IPA severity.Conclusion:Striae gravidarum (SG) was found to be associated with scar characteristics, but not associated with the severity of intraperitoneal adhesion (IPA).

Risk factors associated with secondary infertility in women of childbearing age: A matched case–control study

Background: Childbearing and rearing are important events in every human life and are associated with the feeling of completeness, family integration, and happiness. However, approximately 1 in 10 couples worldwide experience difficulty in achieving conception. Objective: This study aims to determine the risk factors associated with secondary infertility in women attending the obstetrics and gynecology clinics of a tertiary hospital in Lagos, Nigeria. Methodology: This individually matched case–control study was carried out from July to October 2015. A total of 160 cases were recruited from the gynecology clinic and 160 matched controls were recruited from the antenatal clinic. Data were collected using a structured interviewer-administered questionnaire. The information collected included sociodemographic characteristics, social history, and obstetric and gynecological history. A conditional logistic regression analysis controlling for possible confounders, which included variables significant at the univariate level, was undertaken. Results: Association with secondary infertility was found with a history of unsafe abortion (adjusted odds ratio [AOR] = 9.3607, confidence interval [CI] = 3.7664–23.2645), alcohol use (AOR = 16.8102, CI = 1.3972–202.2487), family history of secondary infertility (AOR = 4.7346, CI = 1.4892–15.0523), and history of sexually transmitted infections (AOR = 4.5428, CI = 1.7658–11.6866). Contrariwise, a history of regular menses and normal vaginal delivery, respectively, were found to be protective. No statistically significant relationship was observed between educational level or alcohol use of partners and secondary infertility in this study. Conclusion: The extrinsic risk factors identified in this study should be taken into consideration when designing preventive and treatment programs toward reducing the burden of secondary infertility.

226: TOLAC success in twin pregnancies in the United States (2013-2015)

Robust data about the likelihood of successful trial of labor after cesarean delivery (TOLAC) exists for women with singleton pregnancies. We aimed to determine the success of TOLAC in twin pregnancies in the United States between 2013 and 2015. This is a population-based analysis of the TOLAC success rate in twin pregnancies in the United States. We used “Natality” files from the National Center for Health Statistics for 2013-2015. All women with twin gestations who attempted a TOLAC were included in this study. The primary outcome was the mode of delivery and was calculated based on birth certificate data. Multivariable regression analysis was performed to test the effect of age, body mass index, African American race, Hispanic ethnicity, and number of previous cesarean deliveries on likelihood of successful TOLAC. History of prior TOLAC and prior vaginal delivery were not available. Statistical analysis was performed using R-3.4.1. Out of 380,095 total twin births, 60,845 (16.0%) had history of previous cesarean delivery (CD); 42,332 (11.1%) and 13,898 (3.7%) were to mothers with history of one (CD1) and two (CD2) previous CDs, respectively. TOLAC was attempted in 7,570 (12.4%) women [4138 (9.7%) of CD1 versus 713 (5.1%) of CD2]. and was successful in 2437 (47%) of cases [2112 (51%) of CD1 versus 239 (33.5%) of CD2, (P < 0.001)]. Multivariable regression analysis revealed no association between age, African American race, Hispanic ethnicity and number of previous cesarean deliveries with a successful TOLAC (Table). Compared to TOLAC success rates in the medical literature for singleton gestations, the overall likelihood of successful TOLAC appears to be lower in twin pregnancies, specifically in women with 2 prior cesarean deliveries. Since primary CD rates of up to 50% are quoted to exist for twins, factors beyond those proposed to affect the likelihood of successful TOLAC in singleton gestations may play a role in twin gestations. A significant number of women who attempt TOLAC with twins will deliver vaginally, however appropriate counseling is warranted.

Antenatal scoring system in predicting the success of planned vaginal birth following one previous caesarean section

This was a prospective observational study to determine the predictive factors for a successful vaginal birth after caesarean section (VBAC) and to develop a relevant antenatal scoring system. Patients with one previous caesarean section were included in this study. All data including maternal demographics, obstetric history, pregnancy progress and outcomes were collected and analysed. A total of 142 out of the 186 women (76.3%) had successful VBAC. History of previous vaginal delivery and non-recurrent indications for previous caesarean section were the significant predictive factors for a successful VBAC. Five variables for our scoring tool were selected. By using a proposed mean score of 4 out of 7, the scoring system had a sensitivity of 81.0%, specificity of 52.3% and a positive predictive value of 84.6%. VBAC antenatal scoring system was potentially a useful predictive tool in antenatal counselling.Impact statementWhat is already known on this subject: Planned vaginal birth after caesarean section (VBAC) is an important strategy to limit the overall caesarean section rate, which is related to maternal morbidities. However, trial of vaginal delivery does involve potential complications including scar dehiscence, postpartum haemorrhage and emergency hysterectomy.What the results of this study add: Clinical predictors of a successful VBAC include non-recurrent indications for the previous caesarean section, previous vaginal delivery, spontaneous onset of labour and birthweight less than 4kg. There were multiple screening tools developed to predict the likelihood of successful VBAC. These scoring systems involved various variables such as age, ethnicity, Bishop’s score and previous caesarean indication. We had prospectively developed an antenatal scoring system based on five variables. Our result showed that patient with a score of four and above will have around 85% chance of successful VBAC.What the implications are of these findings for clinical practice and/or further research: We have also found that, estimated foetal weight based on ultrasound scan is a potential predictor for successful VBAC. This simple scoring method will be useful in-patient counselling regarding mode of delivery after one previous caesarean section. A multicentre study involving large cohort of patients is ideal to validate our scoring system.