Published: 2018-10-25

Obstetrical outcome in post caesarean pregnancy

Anitha Aldur Manjappa, Soundara Raghavan Subrahmanian


Background: Rates of caesarean delivery have increased over past 40 years. The increase has been attributed to liberalization of indications for caesarean sections. Repeat caesarean section is a major contributor to caesarean rates; Vaginal Birth After Caesarean (VBAC) is one of the methods to contain increasing caesarean rates. Success rates of 60-80% have been reported.

Methods: This was a descriptive study involving 1000 pregnancies of period of gestation more than 28 weeks with history of one previous caesarean section. The women under study were subjected to either trial vaginal delivery or elective repeat caesarean delivery depending upon the clinical situation. The percentage of successful vaginal deliveries, factors responsible for failure of vaginal delivery and differences in outcome between successful vaginal delivery and caesarean delivery group were analyzed.

Results: Out of the 1000 women, 423 underwent elective repeat caesarean delivery, of the remaining 577, 403 (69.8%) had successful vaginal delivery. Age of the woman and onset of labour were the only factors influencing the success of vaginal delivery. Women aged 35 years or more and women who needed labour induction had lower success of vaginal delivery. Maternal and perinatal outcome were worse in failed vaginal delivery group when compared to elective repeat caesarean delivery or successful vaginal delivery groups.

Conclusions: Factors which are usually thought to influence the decision about trial vaginal delivery like prior vaginal delivery, indication for previous caesarean section and interpregnancy interval are not absolute in determining the decision or the outcome. Labour induction should be resorted with great caution in women with post caesarean pregnancy.


Previous caesarean pregnancy, Trial of vaginal delivery, Vaginal birth after caesarean section

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Vogel JP, Betrán AP, Vindevoghel N, Souza JP, Torloni MR, Zhang J et al. on behalf of the WHO Multi-Coun¬try Survey on Maternal and Newborn Health Research Network. Use of the Robson classification to assess caesarean section trends in 21 countries: a secondary analysis of two WHO multicountry surveys. Lancet Global Health 2015;3(5):e260-70.

Ye J, Betran AP, Vela MG, Souza JP, Zhang J. Searching for the Optimal Rate of Medically Necessary Caesarean Delivery. Birth. 2014;41(3):237-43.

Rosenstein MG, Kuppermann M, Gregorich SE, Cottrell EK, Caughey AB, Cheng YW. Association between Vaginal Birth after Caesarean Delivery and Primary Caesarean Delivery Rates. Obstet Gynecol 2013;122(5):1010.

Lumbiganon P, Laopaiboon M, Gulmezoglu AM, Souza JP, Taneepanichskul S, Ruyan P, et al: Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007- 08. Lancet. 2010;375(9713):490-9.

Villar J, Carroli G, Zavaleta N, Donner A, Wojdyla D, Faundes A, et al. Maternal and neonatal indivi¬dual risks and benefits associated with caesarean delivery: multicentre prospective study. BMJ. 2007;335(7628):1025.

WHO Statement on Caesarean Section Rates - World Health Organization Available at

Sreevidya S, Sathiyasekaran BW: High caesarean rates in Madras (India): a population-based cross-sectional study. BJOG. 2003;110(2):106-11

Royal College of Obstetricians and Gynaecologists. Birth After Previous Caesarean Birth. Green-top Guideline No. 45. London: RCOG;2015(45).

Barger MK, Dunn JT, Bearman S, DeLain M, Gates E. A survey to access to trial of labour in California hospitals in 2012.BMC Preg Childbirth. 2013; 13(1):83

Leeman LM,Beagle M,Espey E, Ogburn T,Skipper B et al.Diminshing availability of trial of labour after Caesarean delivery in New Mexico hospitals.Obstet Gynecol. 2013;122(2):242.

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

American College of Obstetricians and Gynecologists.Vaginal Birth after Caesarean delivery. Practice Bulletin No. 184, Obstet Gynecol. 2017;130(5):e217-33

American College of Obstetricians and GynecologistsVaginal birth after previous Caesarean delivery. Practice bulletin no. 115: Obstet Gynecol 2010;116(2 Pt 1):450-63.

Cunningham FG, Levono KJ, Bloom SL, Dashe JS, Hoffman BL, Casey BM, et al. Prior Caesarean Delivery. Williams Obstetrics 25th ed. McGraw-HILL; New Delhi: 2018:899-918.

Raja JF, Bangash KT, Mahmud G. VBAC Scoring: Successful vaginal delivery in previous one caesarean section in induced labour. 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.

Landon MB, Leindecker S, Spong CY, Hauth JC, Bloom S, Varner MW, et al. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. The MFMU Caesarean Registry: factors affecting the success of trial of labour after previous Caesarean delivery. Am J Obstet Gynecol. 2005;193(3):1016-23.

Wing DA, Paul RH: Vaginal birth after Caesarean section. selection and management. Clin Obstet Gynecol. 1999;42(4):836.

Peaceman AM, Gersnoviez R, Landon MB, Spong CY, Leveno KJ, Varner MW, et al. The MFMU Caesarean registry: impact of fetal size on trial of labour success for patients with previous caesarean for dystocia. Am J Obstet Gynecol 2006;195(4):1127.

Huang WH, Nakashima DK,Rumney PJ, Keegan KA Jr, Chan K. Interdelivery interval and the success of vaginal birth after Caesarean delivery Obstet and Gynecol. 2002;99(1):41-4.

Bujold E, Gauthier RJ. Risk of uterine rupture associated with an Interdelivery interval between 18 and 24 months. Obstet Gynecol. 2010; 115(5):1003-6.

Kessous R, Sheiner E. Is there an association between short interval from previous Caesarean section and adverse obstetric and perinatal outcome? J Matern Fetal Neonatal Med. 2013; 26(10):1003-6.

Guise JM, Eden K, Emeis C, Denman MA, Marshall N, Fu R, et al. Vaginal Birth after Caesarean: New Insights. Evidence Reports/ Technology Assessments, No. 191. Rockville, Maryland, USA: Agency for Healthcare Research and Quality; 2010(191);1.

Dekker GA, Chan A, Luke CG, Priest K, Riley M, Halliday J, et al. Risk of uterine rupture in Australian women attempting vaginal birth after one prior caesarean section: a retrospective population-based cohort study. BJOG 2010;117(11):1358-65.

Fitzpatrick KE, Kurinczuk JJ, Alfirevic Z, Spark P, Brocklehurst P, Knight M. Uterine rupture by intended mode of delivery in the UK: a national case-control study. PLoS Med 2012;9(3):e1001184.

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.

Thapsamuthdechakorn A, Sekararithi R, Tongsong T. Factors Associated with Successful Trial of Labour after Caesarean Section: A Retrospective Cohort Study. J Preg. 2018(2):1-5.

Jain R.Safety of vaginal birth after single previous lower segment caesarean: a retrospective analysis of 200 cases. Int J Reprod Contracept Obstet Gynecol 2018;7(7):2596-602.

Mishra N, Taori N, Misri A. Fetomaternal outcome of pregnancy with previous Caesarean section. J Evolution Med and Dent Sci. 2014;3(47):11369-78.

Rossi AC, D'Addario V. Maternal morbidity following a trial of labour after Caesarean section vs elective repeat Caesarean delivery: a systematic review with metaanalysis. Am J Obstet Gynecol. 2008;199(3):224-31.

Hammad IA, Chauhan SP, Magann EF, Abuhamad AZ.Peripartum complications with Caesarean delivery: a review of Maternal-Fetal Medicine Units Network publications. J Matern Fetal Neonatal Med 2014;27(5):463-74.

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 randomized trial. PLoS Med. 2012;9(3):e1001192.