DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20201085

Assessing the pros and cons of vaginal birth after caesarean relative to elective repeat caesarean section

Sangeeta G. Prasad, Preeti Malhotra

Abstract


Background: Recent years have witnessed a rise in rate of primary caesarean section (CS). No. of women reporting with a previous CS scar is also increasing. Judicious trial of labor in such patients can prevent repeat caesarean section. Aim of this study was to assessing the safety and success rate of vaginal birth after caesarean (VBAC) in selected cases of patients who have undergone previous lower segment CS (LSCS) is the main aim of this study.

Methods: In this prospective observational study carried out in a tertiary care teaching hospital over a period of 1 year. 375 pregnant women with a history of one previous LSCS for non-recurrent indications were enrolled. The statistical technique of t-test was administered for relative comparison with respect to maternal and neonatal complications across the two groups, i.e. repeat LSCS and vaginal delivery.

Results: Out of 375 patients 187 patients (49.9%) underwent elective LSCS for recurrent indication and for non-recurrent indication associated with some complicating factor. Trial of labor in 188 (50.10%) was given out of which 59.3% had spontaneous vaginal delivery,7.20% had instrumental delivery and 33.50% landed into emergency CS. Commonest cause of Em. LSCS being Fetal distress. As regards maternal complications, no statistically significant difference was found between the Repeat LSCS and Vaginal delivery groups (t = 0.779, p > 0.05). On similar lines, there was no statistically significant difference across both groups as regards neonatal complications (t = 0.632, p > 0.05).

Conclusions: Taking into account the increased trend of primary CS, trial of VBAC in selected cases is very important. It can be concluded that VBAC has chances of success in cases with previous one LSCS but it must be carefully investigated and monitored.


Keywords


Elective caesarean section, Lower segment cesarean section, Vaginal birth after cesarean section

Full Text:

PDF

References


Ugwumadu A. Does the maxim “once a caesarean, always a caesarean” still hold true? PLoS Med. 2005;2(9):e305.

Hibbard JU, Gilbert S, Landon MB, Hauth JC, Leveno KJ, Spong CY, et al. Trial of labor or repeat cesarean delivery in women with morbid obesity and previous cesarean delivery. Obstet Gynecol. 2006;108(1):125-33.

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

O’Brien-Abel N. Uterine rupture during VBAC trial of labor: risk factors and fetal response. J Midwifery Women's Health. 2003;48(4):249-57.

Cox KJ. Counseling women with a previous cesarean birth: toward a shared decision-making partnership. J Midwifery Womens Health. 2014;59(3):237-45.

Gyamfi C, Juhasz G, Gyamfi P, Stone JL. Increased success of trial of labor after previous vaginal birth after cesarean. Obstet Gynecol. 2004;104(4):715-9.

Eden KB, McDonagh M, Denman MA, Marshall N, Emeis C, Fu R, et al. New insights on vaginal birth after cesarean: can it be predicted? Obstet Gynecol. 2010;116(4):967-81.

Smith GC, Pell JP, Cameron AD, Dobbie R. Risk of perinatal death associated with labor after previous cesarean delivery in uncomplicated term pregnancies. JAMA. 2002;287(20):2684-90.

Rietveld AL, Kok N, Kazemier BM, de Groot CJ, Teunissen PW. Trial of labor after cesarean: attempted operative vaginal delivery versus emergency repeat cesarean, a prospective national cohort study. J Perinatol. 2015;35(4):258-62.

Studsgaard A, Skorstengaard M, Glavind J, Hvidman L, Uldbjerg N. Trial of labor compared to repeat cesarean section in women with no other risk factors than a prior cesarean delivery. Acta Obstet Gynecol Scand. 2013;92(11):1256.

Dhillon BS, Chandhiok N, Bharti S, Bhatia P, Coyaji KJ, Das MC, et al. Vaginal birth after cesarean section (VBAC) versus emergency repeat cesarean section at teaching hospitals in India: an ICMR task force study. Int J Reprod Contracept Obstet Gynecol. 2014;3:592-7.

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.

Chhabra S, Arora G. Delivery in women with previous cesarean section. J Obstet Gynaecol India. 2006;56:304-7.

Bujold E, Bujold C, Hamilton EF, Harel F, Gauthier RJ. The impact of a single layer or double layer closure on uterine rupture. Am J Obstet Gynecol. 2002;186:1326-30.

Shah SR, Prasad P. Outcome of labor in previous one lower segement cesarean section cases. Asian J Obstet Gynecol Pract. 2006;10:7-11.

Dodd J, Crowther C. Vaginal birth after cesarean versus elective repeat cesarean for women with a single prior cesarean birth: a systemic review of the literature. Aust NZJ Obstet Gynaecol. 2004;44:387-91.

Hutton EK. Elective repeat caesarean delivery versus trial of labor: a meta-analysis of the literature from 1989 to 1999. Am J Obstet Gynecol. 2000;183:1187-97.