Email this article Assessment of maternal and fetal outcome in trial of labor after cesarean
Abstract
Background: Nowadays, cesarean sections are increasing consistently. Repeat cesarean sections are performed for a large percentage and associated with a higher rate of surgical complications and Long-term morbidities. The trial of labor after cesarean offers an alternative choice. This study carried out to assess the maternal and fetal outcome and to evaluate various parameters as a predictor of success of TOLAC.
Methods: This prospective observational study conducted on 150 pregnant women with one previous LSCS who delivered at Mahatma Gandhi hospital, from January 2017 to July 2018. Patient having a singleton pregnancy, cephalic presentation, adequate pelvis size with spontaneous onset of labor were included. Cases were monitored carefully during the labor. Emergency LSCS was done if any indication appeared.
Results: 78% of cases delivered safely by the vaginal birth and 22% of cases had an emergency repeat cesarean section (EmRCS). Favorable Bishop Score, active stage of labor and prior vaginal delivery were associated with higher success rate. One (0.66%) case of uterine scar rupture and 2 (1.33%) cases of scar dehiscence noted. No maternal mortality observed. Perinatal mortality occurred in 2 cases (1.33%).
Conclusions: Present study shows that appropriate clinical settings and the properly selected group of patients can make the TOLAC safe and effective.
Keywords
Full Text:
PDFReferences
American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 184: Vaginal Birth After Cesarean Delivery. Obstet Gynecol 2017;130:e217-33.
Dweik D, Girasek E, Mészáros G, Töreki A, Keresztúri A, Pál A. Non-medical determinants of cesarean section in a medically dominated maternity system. Acta Obstet Gynecol Scand. 2014;93(10):1025-33.
“WHO” news release. Cesarean sections should only be performed when medically necessary. Geneva. 10 April 2015.
Chan A, Scott J, Nguyen A, Keane R. Pregnancy outcome in South Australia 2000. Adelaide: Pregnancy Outcome Unit, Department of Human Services; 2001.
Silver, RM, Landon, MB, Rouse, DJ; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network: Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol. 2006;107:1226-32.
RCOG. Birth After Previous Caesarean Birth. Green-top guideline 45. Oct 2015.
Zaitoun MM, Eldin SAN, Mohammad EY. A prediction score for safe and successful vaginal birth after cesarean delivery: a prospective controlled study. J Women’s Health Care. 2013;2:129.
Tater A, Garg S, Jawa A, Jain M. Safety and efficacy of a trial of labor after cesarean. Int J Reprod Contracept Obstet Gynecol. 2016;5:4335-8.
Haresh UD, Rohit KJ, Aarti AV. Prognostic factors for successful vaginal birth after cesarean section - Analysis of 162 cases. J Obstet Gynecol India. 2010;60:498-502.
Guise JM, Denman MA, Emeis C, Marshall N, Walker M, et al. Vaginal birth after cesarean: new insights on maternal and neonatal outcomes. Obstet Gynecol. 2010;115:1267-72.
Bangal VB, Giri PA, Shinde KK, Gavhane SP. Vaginal birth after cesarean section. North Am J Med Sci. 2013;5(2):140-4.
Balachandran L, Vaswani PR, Mogotlane R. Pregnancy outcome in women with previous one cesarean section. JCDR. 2014;8(2):99-102.
Singh PS, Bamaniya J, Shah A. Factors predicting the success of trial of labor after cesarean in the current scenario. Int J Reprod Contracept Obstet Gynecol. 2016;5:3893-7.
Patel RM, Kansara VM, Patel SK, Anand N. Impact of FLAMM scoring on cesarean section rate in previous one lower segment cesarean section patient. Int J Reprod Contracept Obstet Gynecol. 2016;5:3820-3.
Li WH, Yang MJ, Wang PH, Juang CM, Chang YW, Wang HI, et al. Vaginal birth after cesarean section: 10 years of experience in a tertiary medical center in Taiwan. Taiwanese J Obstet Gynecol. 2016;55(3):394-8.
