DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20163847

Impact of FLAMM scoring on cesarean section rate in previous one lower segment cesarean section patient

Riddhi M. Patel, Vijay M. Kansara, Seema K. Patel, Nikhil Anand

Abstract


Background: The aim of this study was to evaluate the impact of Flamm scoring for Successful VBAC (vaginal birth after cesarean) and Failed TOLAC (Emergency cesarean section) in case of previous one lower segment cesarean delivery.

Methods: This is prospective observation study. Out of 150, 111 patients gave consent for TOLAC. 111 patients with previous one caesarean section with gestational weeks between 37 to 40 weeks with spontaneous onset of labour admitted in labour room of Obstetrics and Gynecology Department in Sola Civil Hospital over a period of 1 year from April 2014 to April 2015.

Results: In the present study, 111 (74%) patients had undergone TOLAC trial. Out of 111, 77(69.36%) patients had successful VBAC whereas 34 (30.63%) had emergency cesarean. Among the successful VBAC, 7 patients had assisted vaginal delivery to cut short the second stage in prolonged labour. 26% patients refused to give consent for TOLAC from total number of patients in this study. Mean FLAMM score for Successful VBAC was 5.35 (95% CI, 3.9 to 6.7) compared to Failed TOLAC (EME CS) was 3.62 (95% CI, 3.27 to 4.57) Chances of success of TOLAC was increased with increasing FLAMM score according to this study.

Conclusions: Application of FLAMM scoring gives fare judgment of successful vaginal birth in TOLAC. So FLAMM scoring can be applied in each previous one lower segment cesarean section patient undergoing TOLAC without increasing morbidity. Practice of protocol of applying FLAMM score and monitoring by partogram will reduce the rate of cesarean section in previous one lower segment cesarean section patient.


Keywords


EMECS, Failed TOLAC, Successful VBAC, Scar dehiscence

Full Text:

PDF

References


Klein L. New guidelines to reduce repeat cesareans. American College of Obstetricians and Gynecologists ACOG, Washington, DC 1985.

Committee opinion No. 164. Guidelines for Vaginal delivery after previous cesarean birth. American College of Obstetricians and Gynecologist, ACOG, Washington, DC 1988.

American College of Obstetricians and Gynecologists. Vaginal birth after previous cesarean. ACOG Practice Bulletin No. 54. Obstet Gynecol. 2004;104:203-12.

Ebell MH, Georgia A. Predicting the Likelihood of Successful Vaginal Birth after Cesarean Delivery. American Family Physician. 2007;76(8):1192-4.

McMahon MJ, Luther ER, Bowes WA, Olshan AF. Comparison of a trial of labor with an elective second cesarean section. N Engl J Med. 1996;335(10):689-95.

Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Menacker F, Kirmeyer S. Births: final data for 2004. Hyattsville, Md.: National Center for Health Statistics, 2006. DHHS publication no. (PHS) 2006-1120. Accessed July 10, 2007. at: http://www.cdc.gov/nchs/data/nvsr/nvsr55/nvsr55_01.pdf.

Guise JM, McDonagh MS, Hashima J, Kraemer DF, Eden KB, Berlin M. Vaginal birth after cesarean (VBAC) volume 1 and volume 2. Rockville, Md.: Agency for Healthcare Research and Quality, March 2003. AHRQ publication no. 03-E018. Accessed July 10, 2007, at: http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat1a.chapter.7149

Lydon-Rochelle M, Holt VL, Easterling TR, Martin DP. Risk of uterine rupture during labor among women with a prior cesarean delivery. N Engl J Med. 2001;345:3.

Clark SL, Hankins GD. Temporal and demographic trends in cerebral palsy fact and fiction. Am J Obstet Gynecol. 2003;188:628-33.

Lee HC, El-Sayed YY, Gould JB. Population trends in cesarean delivery for breech presentation in the United States, 1997-2003. Am J Obstet Gynecol. 2008;199:59.e1-59.8.

Goetzinger KR, Macones GA. Operative vaginal delivery: current trends in obstetrics. Womens Health. 2008;4:281-90.

Committee opinion No. 143. Vaginal delivery after previous cesarean birth. American College of Obstetricians and Gynecologists, ACOG, Washington, DC 1994.

NIH Vaginal Birth after Cesarean (VBAC) Conference - Panel Statement. Consensus.nih.gov. Retrieved 2013-05-16.

Menacker F, Declercq E, Macdorman MF. Cesarean delivery: background, trends, and epidemiology. Semin Perinatol. 2006;30:235-41.

Uddin SF, Simon AE. Rates and success rates of trial of labor after cesarean delivery in the United States, 1990-2009. Maternal Child Health J. 2013;17:1309.

Vaginal Birth after Cesarean: New Insights: Structured Abstract. Ahrq.gov. 16 September 2010.

Harper LM, Macones GA. Predicting success and reducing the risks when attempting vaginal birth after cesarean. Obstet Gynecol Surv. 2008;63:538-45.

Flamm BL, Geiger AM. Vaginal birth after cesarean delivery: an admission scoring system. Obstetrics and Gynecology. 1997;90(6):907-10.

Dinsmoor MJ, Brock EL. Predicting failed trial of labor after primary cesarean delivery. Obstetrics and Gynecology. 2004;103(2):282-6.