Trail of labor versus elective repeat cesarean section: a comparison of morbidity and mortality at tertiary care teaching hospitals in India
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20184492Keywords:
Elective repeat cesarean section, Maternal, Morbidity and mortality, Trial of labor after cesareanAbstract
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.
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.
