Study of obstetric and fetal outcome of post caesarean pregnancy

Akanksha Nigam, Rakesh Anand, Niyati Jain

Abstract


Background: With the sky rocketing caesarean section rates an increasing number of women face the issue of mode of delivery in their current pregnancy. There are conflicting reports regarding the safety of a trial for Vaginal Birth After Caesarean delivery (VBAC) in terms of uterine rupture and concern about, maternal and perinatal morbidity. The purpose of this study was to evaluate the obstetric and fetal outcomes of patients presenting at term with a history of previous LSCS.

Methods: A one year prospective observational study was conducted where in all patients who had a term pregnancy with a history of prior LSCS were included in the study after obtaining their consent for participation. The obstetric and fetal outcomes of these patients in the present pregnancy were noted and tabulated. A descriptive analysis of these outcomes was carried out.

Results: 100 patients at term, with a history of previous LSCS were studied. Of these, trial for a VBAC was attempted by 50 patients of these 46% (23) had a successful VBAC. And remaining 54% went for emergency LSCS. 50% patients underwent an elective repeat caesarean deliver. Scar dehiscence was seen in 2.72% of the patients who opted for a trial for VBAC. Perinatal morbidity was higher in cases of repeat caesarean delivery than in those who had a successful VBAC (12.12% vs. 0 percent). Maternal complications were also higher in patients who had a repeat LSCS compared to those who had a successful VBAC.

Conclusions: With an increase in the proportion of patients with a history of previous LSCS, it is essential for health care institutions to have proper antenatal counseling regarding VBAC and a well-defined management protocol in place in an effort to increase the number of VBACs and bring down the overall caesarean rates. Patients with a history of prior vaginal delivery have an increased likelihood for a successful VBAC. A successful VBAC is associated with a lower perinatal and maternal morbidity than repeat caesarean delivery, and this is relevant for counseling women about their choices after a caesarean delivery.


Keywords


Previous LSCS, Post caesarean pregnancy, VBAC, Maternal outcomes, Fetal outcomes

Full Text:

PDF

References


Curtin SC. Rates of caesarean birth and VBAC, 1991-95. Monthly vital statistics report. Natl Center Health Statist. 1997;45(11 Suppl 3):1-12.

United States, 1991. Rates of caesarean delivery. MMWR Morb Mortal Wkly Rep. 1993;42:285-9.

Stafford RS. Alternative strategies for controlling rising caesarean section rates. JAMA. 1990;263:683-7.

Cragin EB. Conservatism in obstetrics. NY Med J. 1916;104(1):1-3.

Menacker F, Curtin SC. Trends in caesarean birth and vaginal birth after previous caesarean, 1991-99. Natl Vital Stat Rep. 2001;49:1-16.

Rosen MG, Dickinson JC, Westhoff CL. Vaginal birth after caesarean: a meta-analysis of morbidity and mortality. Obstet Gynecol. 1991;77:465-70.

Jhaveri A. Obstetric career after previous caesarean section. J Obstet Gyncol India. 1969;19:561.

Parliamentary Office of Science and Technology. Caesarean sections. Postnote. 2002;184:1-4.

Landon MB, Hauth JC, Leveno KJ, Spong CY, Leindecker S, Varner MW, et al. Maternal & Perinatal outcomes associated with a trial of labour after prior caesarean delivery. N Engl J Med. 2004;351:2581-9

Smith GC, Pell JP, Cameron AD, Dobbie R. Risk of perinatal death associated with labor after previous caesarean delivery in uncomplicated term pregnancies. JAMA. 2002;287:2684-90.

Yeh J, Wactawski-Wende J, Shelton JA, Reschke J. Temporal trends in the rates of trial of labor in low risk pregnancies and their impact on the rates and success of vaginal birth after caesarean delivery. Am J Obstet Gynecol. 2006;194:144.

Gonen R, Nisenblat V, Barak S, Tamir A, Ohel G. Results of a well-defined protocol for a trial of labour after prior caesarean section. Obstet Gynecol. 2006;107:240-5.

Mercer BM, Gilbert S, Landon MB, Spong CY, Leveno KJ, Rouse DJ, et al. Labor outcomes with increasing number of prior vaginal births after caesarean delivery. Obstet Gynecol. 2008;111:285-91.

Mozurkewich EL, Hutton EK. Elective repeat caesarean delivery versus trial of labor: a meta-analysis of the literature from 1989 to 1999. Am J Obstet Gynecol. 2000;183:1187-97.

American College of Obstetricians and Gynecologists Committee on Obstetric Practice Bulletins. ACOG Practice Bulletin No. 54: Vaginal birth after previous caesarean delivery. Obstet Gynecol. 2004;104:203-12.

RCOG. Birth after previous caesarean birth. In: RCOG, eds. RCOG Green Top Guideline No. 45. London (UK): RCOG; 2007: 17.