DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20184492

Trail of labor versus elective repeat cesarean section: a comparison of morbidity and mortality at tertiary care teaching hospitals in India

Balwan Singh Dhillon, Nomita Chandhiok, M. Vishnu Vardhana Rao

Abstract


Background: As cesarean birth rates continue to rise, more women are faced with the choice of planning a vaginal delivery or a repeat cesarean section after a previous cesarean section. The objective of this prospective study was to study the morbidities and mortality of women attempting a trial of labor after cesarean (TOLAC) versus elective repeat cesarean section (El-RCS).

Methods: Prospective data was recorded on management practices, associated complications and morbidity & mortality for a period of 8 months on 15664 consecutive cases of previous cesarean section reporting at 30 medical colleges/ teaching hospitals for delivery.

Results: A trial of labor was planned in 25.8% (4035) women and 34.5% (5399) women underwent elective repeat cesarean section and rest had emergency repeat cesarean section. Overall maternal morbidity due to any cause was 20.7% among El-RCS as compared to 14.2% in TOLAC which was statistically significant (OR: 1.57, CI: 1.41-1.76, P=0.00). Blood loss of more than 1000ml was around 8.0% among TOLAC where as in El-RCS it was 8.8% (OR: 0.89, CI: 0.77-1.94, p=0.14 not statistically significant). Blood transfusion was given in 3.7% in TOLAC where as in El-RCS it was given in 6.5% (OR: 0.56, CI: 0.45-0.68, p=0.00 highly significant).  Complication like dehiscence of scar was similar in both groups. Post-operative complication were seen in 2.8% cases in TOLAC where as in El-RCS it was 5.8% (OR: 0.47, CI: 0.38-0.59, p=0.00 highly significant). Uterine rupture was 0.3% in TOLAC where as in El-RCS it was 0.7% (OR: 0.43, CI: 0.21-0.87, p=0.009 statistically significant). Maternal mortality was reported in 0.2% cases of TOLAC as compared to 0.1% cases in El-RCS (p=0.17) which was not statistically significant.

Conclusions: Maternal morbidity was found to be more in elective repeat cesarean section than trial of labor after cesarean section.


Keywords


Elective repeat cesarean section, Maternal, Morbidity and mortality, Trial of labor after cesarean

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References


Craigin EB. Conservatism in obstetrics. New York Med J. 1916;104:1-3.

Rosen MG, Dickinson JC, Westhoff CL. Vaginal birth after cesarean: a meta-analysis of morbidity and mortality. Obstet Gynecol. 1991;77(3):465-70.

Mozurkewich EL, Hutton EK. Elective repeat cesarean delivery versus trial of labor: a metaanalysis of the literature from 1989 to 1999. Am J Obstet Gynecol. 2000;183(5):1187-97.

American College of Obstetricians and Gynecologist Vaginal Birth After Previous Cesarean Delivery Practice Bulletin No 115. Washington, DC: American College of Obstetricians and Gynecologist 2010; 116(2):450-463.

Vogel JP, Betran AP, Vindevoghel N, Souza JP, Torloni MR, Zhang J, et al. Use of the Robson classification to assess caesarean section trends in 21 countries: a secondary analysis of two WHO multicountry surveys. Lancet Glob Health 2015;3(5):e260-270.

Guise JM. Vaginal delivery after caesarean section. Br Med J. 2004; 329:359-60.

Pridjian G, hibbard JU, moawad AH .cesarian: changing the trends. Obstet Gynecol 1991;77(7462): 195-200.

Sachs BP, Kobelin C, Castro MA, Frigoletto F. Yhe risk of lowering the cesarian delivery rate. New Eng J Med 1999;340(1);54-7

Miller AD, Diaz FG, Paul RH. Vaginal birth after caesarean: a 10-year experience. Obstet Gynecol. 1994;84(2):255-8.

Bhat BPR, Savant R, Kamath A. Outcome of a post caesarean pregnancy in a tertiary center of a developing country. J Clin Diag Res. 2010:4(1):2005-9.

Dhall K, Mittal SC, Grover V et al. Childbirth following primarycesarean section-evaluation of a scoring system. Int J Gynecol Obstet. 1987;25(3):199-201.

Singh T, Clark SC, Toffel S. Changes in cesarean delivery in the United States, 1988 and 1993. Birth 1995;22(2):63-7.

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

Cowan RK, Kinch RA, Ellis B, Anderson R. Trial of labour following caesarean delivery. Obstet Gynecol 1994;83(6):933-6

Iloabachie CC. Delivery after a caesarean section. A review of 836 cases. Trop J Obstet Gynaecol. 1981;7:9-10

Ezechi OC, Nwokoro CA, Kalu BKE, Njokanma FO, Okeke GCE. Caesarean morbidity and mortality in a private hospital in Lagos Nigeria. Trop J Obstet Gynaecol. 2002;19:97-100

Flamm BL, Goings JR, Liu Y, Wolde-Tsadik G. Elective repeat cesarean delivery versus trial of labor: a prospective multicenter study. Obstet Gynecol. 1994;83(6):927-32.

Gellman E, Goldstein MS, Kaplan S, Shapiro WJ. Vaginal delivery after cesarean section: experience in private practice. JAMA 1983;249(21):2935-7.

Gibbs CE. Planned vaginal delivery following cesarean section. Clin Obstet Gynecol 1980;23(2):507-15.

Dhillon BS, Chandhiok N, Shukla DK. Maternal morbidity and mortality following a trial of labor in women with previous cesarean section at tertiary care teaching hospitals in India. J Med Sci Clinic Res. 2017;05(09):27587-92.