Maternal and perinatal outcome in trial of labour after caesarean at tertiary care hospital: a prospective observational study
Keywords:Emergency repeat cesarean delivery (ERCD), Trial of labour after caesarean (TOLAC), Vaginal birth
Background: To compare maternal and perinatal outcomes in trial of labor after cesarean (TOLAC) and Emergency repeat cesarean delivery (ERCD).
Methods: Prospective observational study at tertiary care center for one year. Selection of candidates for Vaginal Birth after caesarean section (VBAC) was based on the 2010 American College of Obstetricians and Gynecologists’ (ACOG) recommendation. The maternal outcome was observed in the form of VBAC success rate, maternal complications, number of days in a hospital stay, The perinatal outcome was observed as 5 minute Apgar score and need for neonatal intensive care unit (NICU) admission.
Results: 250 patients were given trial for vaginal delivery. VBAC success rate was 169/249 (67.9%). 80/249(32.1%) patients required repeat CS. Cases with Bishop score >6 had more rate of vaginal delivery (89.6%) as compared to Bishop score ≤6 (17.4%) (p=<0.01). Spontaneous labour had better VBAC success rate (91.8%) than induced labour (55.5%) (p=<0.01). 8/12 (66.6%) subjects with history of previous vaginal deliveries delivered vaginally. 5/169 of VBAC babies had low 5-minute Apgar score as compared to 3/80 from repeat CS.
Conclusions: VBAC has the benefits of short hospital stay, decreased morbidity and less expenditure. Considering the fact that fetal morbidity and mortality due to TOL is comparable with the women labouring without a scar, TOL may be encouraged. Women can be given TOL with careful monitoring and taken for emergency LSCS on minimal indication and can be the best answer to management of previous one CS in labour.
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