Safety of vaginal birth after single previous lower segment caesarean: a retrospective analysis of 200 cases
Keywords:Caesarean section, Neonatal and maternal morbidity, Trial of labor, VBAC
Background: Vaginal birth after Caesarean delivery (VBAC) has long been proposed as a viable measure to reduce overall Caesarean delivery rates. The objective of present study was to assess predictive factors and to study outcome of pregnancy in women with one previous lower segment caesarean section underwent trial of scar, in author’s hospital setting.
Methods: This retrospective analysis of 200 pregnant women with one previous lower segment caesarean section underwent trial of scar, was carried out over a period of one year, in department of Obstetrics and Gynaecology, Gajra Raja Medical College, Gwalior (M.P.). The maternal and neonatal data and data concerning the course of delivery were reviewed and subjected to statistical analysis.
Results: The success rate of VBAC was 36%. Young maternal age, gestational age <40 weeks, neonate birth weight 2.5-3 kg, admission in active phase of labor, previous caesarean for malpresentation, meconium stained liquor and fetal distress, were associated with successful VBAC. The commonest indication of repeat caesarean section was non-progress of labor in 34.37% women. Admission rate to neonatal intensive care unit was less in VBAC (2.77%) than in repeat caesarean section group (7.03%). There was one case of uterine rupture. There were 3 perinatal deaths and no maternal deaths.
Conclusions: Women with a prior caesarean section are at increased risk of subsequent caesarean. Vaginal birth after caesarean should be encouraged in selected cases to reduce the risks of repeated caesarean sections. However, in the event of a failed trial, there is a definite increase in neonatal and maternal morbidity which is also reflected in our study.
Cunningham FG, Levono KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY. Caesarean Delivery and Peripartum Hysterectomy. In: Editors, Williams Obstetrics. 23rd ed. New York: McGraw Hill Medical; 2010:544-567.
Royal College of Obstetricians and Gynaecologists. Birth After Previous Caesarean Birth. Green-top Guideline No. 45. London: RCOG; October 2015.
Seffah JD, Adu-Bonsaffoh K. Vaginal birth after a previous caesarean section: current trends and outlook in Ghana. J West African College of Surgeons. 2014;4(2):1.
Jha M. Pregnancy outcome of single previous Caesarean section. J Nepal Health Res Counc. 2009;(14):25-8.
Crowther CA, Dodd JM, Hiller JE, Haslam RR, Robinson JS. Birth After Caesarean Study Group. Planned vaginal birth or elective repeat caesarean: patient preference restricted cohort with nested randomised trial. PLoS Med. 2012;9(3):e1001192
Bangal VB, Giri PA, Shinde KK, Gavhane SP. Vaginal birth after cesarean section. N Am J Med Sci. 2013;5(2):140.
Ugwu GO, Iyoke CA, Onah HE, Egwuatu VE, Ezugwu FO. Maternal and perinatal outcomes of delivery after a previous Cesarean section in Enugu, Southeast Nigeria: A prospective observational study. Int J Women's Health. 2014;6:301.
Jani RS, Munshi DS. Management of pregnancy with previous lower segment Caesarean section in Modern obstetric practice. NHL J Med Sci. 2013;2(2):59-63.
Landon MB, Hauth JC, Leveno KJ, Sponge YC, Leindecker S, Varner MW. et al. Maternal and perinatal outcomes associated with a trial of labor after prior caesarean delivery. N Engl J Med. 2004;351:2581-9.
Knight HE, Gurol-Urganci I, van der Meulen JH, Mahmood TA, Richmond DH, Dougall A, et al. Vaginal birth after caesarean section: A cohort study investigating factors associated with its uptake and success. BJOG. 2014; 121:183-92.
Raja JF, Bangash KT, Mahmud G. VBAC Scoring: Successful vaginal delivery in previous one caesarean section in induced labor. J Pak Med Assoc. 2013;63(9):1147-51.
Doshi HU, Jain RK, Vazirani AA. Prognostic factors for successful vaginal birth after caesarean section - Analysis of 162 cases. J Obstet Gynecol India. 2010; 60(6):498-502.
Goyal SS, Tiwari M, Hariharan C, Shrivastava DS. Outcome of post caesarean pregnancy and comparison of maternal and fetal outcome following vaginal birth versus repeat caesarean section in a rural hospital. Int J Reprod Contracept Obstet Gynecol. 2013;2(1):16-22.
Bujold E, Gauthier RJ. Risk of uterine rupture associated with an interdelivery interval between 18 and 24 months. Obstet Gynecol. 2010;115:1003-6.
Kessous R, Sheiner E. Is there an association between short interval from previous cesarean section and adverse obstetric and perinatal outcome? J Matern Fetal Neonatal Med. 2013;26:1003-6.
Birara M and Gebrehiwot Y. Factors associated with success of vaginal birth after one caesarean section (VBAC) at three teaching hospitals in Addis Ababa, Ethopia: a case control study. BMC Pregnancy Childbirth. 2013;13:31.
Latika, Kaur G, Singh S. To study the maternal and perinatal outcome following vaginal birth after caesarean section after one previous lower segment caesarean section. Int J Reprod Contracep Obstet Gynaecol. 2015;4(3):658-63.
Mishra N, Taori N, Misri A. Fetomaternal outcome of pregnancy with previous cesarean section. J Evolution Med and Dent Sci. 2014;3(47):11369-78.
Pembe AB, Othman MK. Pregnancy outcome after one previous caesarean section at a tertiary university teaching hospital in Tanzania. Tanzania J Health Res. 2010;12(3):188-94.
Guiliano M, Closset E, Therby D, LeGoueff F, Deruelle P, Subtil D. Signs, symptoms and complications of complete and partial uterine ruptures during pregnancy and delivery. Eur J Obstet Gynecol Reprod Biol. 2014;179:130-4.
Eskandar M, Aboud J, Alshahrani M, Hassanein M, Alyamani A. Optimization of clinical outcome of women with previous one lower segment caesarean section. Open Jpresentnal of Obstetrics and Gynaecology.2012;2(3): 265-269.
Eskandar M, Aboud J, Alshahrani M, Hassanein M, Alyamani A. Optimization of clinical outcome of women with previous one lower segment cesarean section. Open J Obstet Gynecol. 2012;2(03):265.