A prospective observational study of role of epidural in trial of labour after cesarean section in view of maternal and neonatal outcome in a tertiary care hospital
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20202321Keywords:
Epidural, Trial of labor after caesarean, Vaginal birth after cesarean sectionAbstract
Background: In a well-equipped hospital, trial of vaginal delivery is done in selected cases of previous C-section (CS). Epidural analgesia administration has been proved to be good adjunct in trial of labor after caesarean (TOLAC).
Methods: This study is a prospective observational study done in a tertiary care institution in Tamil Nadu from May 2019 to July 2019. 50 cases with previous history of one CS were selected. Single ton pregnancy, previous transverse lower segment cesarean section admitted cases with adequate pelvis with no other co-morbidities were selected. Epidural analgesia was administered once mother was in established labor. TOLAC was continued till satisfactory progress and emergency repeat caesarean was taken in case of Suspected scar dehiscence (SSD) or abnormal fetal heart rate tracings. Quantitative data was expressed in mean and standard deviation. For qualitative data percentage was used.
Results: In 50 cases observed the mean age of the cases was 26±3.64 years. TOLAC was successful in 41 (82%) mothers out of 50. The mode of delivery in 41 TOLAC mothers was found to be forceps in 18 cases (36%) and ventouse delivery 18 cases (36%). Only 9 cases had needed emergency CS (18%). The major indication for CS in TOLAC was found to be fetal distress in 4 number of cases (8%). 43 babies delivered were healthy, 6 babies (12%) admitted in NICU.
Conclusions: With the application of epidural analgesia on attempted vaginal delivery in previous cesarean, vaginal delivery was 82% cases.
References
Royal College of Obstetricians and Gynaecologists (RCOG). Birth after previous caesarean section. Green-Top Guideline No. 45 London: RCOG; 2007. Available at: https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg45/. Accessed on 10th April 2019.
American College of Obstetricians and Gynecologists (ACOG). Vaginal birth after previous cesarean delivery. Washington, DC: ACOG, 2010. Available at: http://dx.doi.org/10.1097/AOG.0b013e3181eeb251. Accessed on 10th April 2019.
World Health Organization. Appropriate technology for birth. Lancet. 1985;2:436-7.
MacDorman M, Declercq E, Menacker F. Recent trends and patterns in cesarean and vaginal birth after cesarean (VBAC) deliveries in the United States. Clin Perinatol. 2011;38:179-92.
Homer CS, Johnston R, Foureur MJ. Birth after caesarean section: changes over a nine-year period in one Australian state. Midwifery. 2011;27:165-9.
Black C, Kaye J, Jick H. Cesarean delivery in the United Kingdom: time trends in the general practice research database. Obstet Gynecol. 2005;106:151-5.
Grisaru-Granovsky S, Bas-Lando M, Drukker L, Haouzi F, Farkash R, Samueloff A, et al. Epidural analgesia at trial of labor after cesarean (TOLAC): A significant adjunct to successful vaginal birth after cesarean (VBAC). J Perinat Med. 2018;46(3):261-9
American College of Obstetricians and Gynecologists (ACOG): ACOG Practice Bulletin: vaginal birth after previous cesarean delivery: Clinical management guidelines. Int J Gynecol Obstet. 2004;54:197-204.
Khotaba S, Volfson M, Tarazova L, Odeh M, Barenboym R, Fait V, et al. Induction of labour in women with previous cesarean section using the double balloon device. Acta Obstet Gynecol Scand. 2001;80:1041-2.
Zeteroglu S, Ustun Y, Engin-Ustun Y, Sahin HG, Kamaci M. Eight years’ experience of uterine rupture cases. J Obstet Gynaecol. 2005;25:458-61.
Kayani SI, Alfirevic Z. Uterine rupture after induction of labor in women with PCS. BJOG. 2005;112:451.
McDonagh MS, Osterweil P, Guise JM. The benefits and risks of inducing labour in patients with prior caesarean delivery: a systematic review. BJOG. 2005;112:1007-15.
Hassan A. Trial of scar and VBAC. J Ayub Med Coll Abbottabad. 2005;17:57.
Turner MJ. Delivery after one previous cesarean section. Am J Obstet Gynecol. 1997;176:741-4.
Zeteroglu S, Ustun Y, Engin-Ustun Y, Sahin HG, Kamaci M. Eight years’ experience of uterine rupture cases. J Obstet Gynaecol. 2005;25:458-61.
McDonagh MS, Osterweil P, Guise JM. The benefits and risks of inducing labour in patients with prior caesarean delivery: A systematic review. BJOG. 2005;112:1007-15.
Dunn EA, O’Herlihy C. Comparison of maternal satisfaction following vaginal delivery after caesarean section and caesarean section after previous vaginal delivery. Eur J Obstet Gynecol Reprod Biol. 2005;121:56-60.
Editorial. Vaginal delivery after caesarean section. Br Med J. 2004;329:359-60.
Pickrell K. An inquiry into the history of cesarean section. Bull Soc Med Hist (Chicago). 1935;4:414.
Konefal H, Jaskot B, Czeszynska MB, Pastuszka J. Remifentanil patient-controlled analgesia for labor - monitoring of newborn heart rate, blood pressure and oxygen saturation during the first 24 hours after delivery. Arch Med Sci. 2013;9(4):697-702.
Shmueli A, Salman L, Nassie DI, Wiznitzer A, Chen R, Ashwal E, et al. The intriguing association between epidural anesthesia and mode of delivery among women in trial of labor after a previous cesarean delivery. Am J Obstet Gynecol. 2017;216(1):S536-7.