Assessment of outcome of Trial of Labour after caesarean in a tertiary hospital based setting : Prospective Observational Study (original) (raw)
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Outcome of post caesarean pregnancy in a tertiary care centre in south India
The New Indian Journal of OBGYN
Objectives: The objective is to estimate the success rate, safety and efficacy of VBAC (vaginal birth after cesarean section) by comparing the maternal and perinatal outcome with the elective repeat cesarean section (ERCS). Methodology: This was a prospective, cohort study done over a period of twelve months in a tertiary care centre. Based on the patients' preference, a total of 211 women who satisfied the inclusion criteria were divided into two groups-either a trial of labour after cesarean section (TOLAC) or ERCS group. Results: Success rate of VBAC was found to be 47.9%. About 15% of failed VBAC was due to the tendency to abandon a TOLAC midway. Although the maternal complications were found to be higher in TOLAC, p value (0.347) was not found to be significant. There was no increased risk of neonatal morbidity and mortality in the TOLAC group when compared to ERCS (p=0.814). There was also no difference found in APGAR scores (<7) at 5 minutes and NICU admissions in the TOLAC group and in ERCS group (p=0.899). Conclusion: The success rate of VBAC was found to be 47.9%. There was no significant risk of maternal and perinatal complications compared to ERCS.
IP innovative publication pvt. ltd, 2019
Introduction: Cesarean section rate has been on a continuous rise since 1970. When trial of scar is done, 30- 80% of women with one previous lower segment caesarean section can achieve vaginal delivery. Identification of the determinants of the success of TOLAC help in selecting the patients with favorable factors and hence improving the success rate of TOLAC with minimum possible complications. Materials and Methods: This study was planned from January 2015 to December 2015. Case files of previous one cesarean pregnancies were reviewed retrospectively in two groups: VBAC group and RCS group. Results: There were 9.8% (N-488) previous one cesarean pregnancies out of which 67% (327) underwent TOLAC. VBAC happened in 71.56% and RCS in 28.44%. Malpresentation, fetal distress, CPD and Failed induction were the indications of primary cesarean which had significantly more number of VBAC as compared to RCS (p value <0.05). There was statistically significant difference in the two groups when the spontaneous onset of labour was compared to induced labour. The mean admission bishops score of VBAC group was 6.952.72 and that of RCS group was 3.87 2.54 (p value- 0.000). Also the mean birth weight of the VBAC group was 2.660.53 and that of RCS group was 2.800.47 (p value- 0.027). Conclusion: Malpresentation, fetal distress, CPD and failed induction are the most important indications of primary cesarean section which have better chances of VBAC. Spontaneous onset of labour, admission bishops score and birth weight has significant affecton the outcome of TOLAC.
Background: Increasing number of women face the issue of mode of delivery in their subsequent pregnancy between a vaginal birth after prior caesarean and elective repeat caesarean delivery. The objective of this study was to determine the feto-maternal outcome and also to find out the maternal and perinatal morbidity and mortality following vaginal birth after CS. Methods: A cross sectional study was carried out in the department of Obstetrics and Gynaecology, Regional Institute of Medical Science, Imphal, Manipur. Data was collected using a self-administered structured interview questionnaire. Ethical clearance was obtained from the Research Ethics Board to carry out the study. Data were entered in IBN SPSS version 21 software for Windows. Results: The totals of 339 pregnant women were included in the study. Most of the pregnant women were in the age group of less than 26 years with the mean age of 29.50±4.45 years. Only 127(37.6%) underwent vaginal delivery out of which only 54(15.9%) underwent spontaneous normal vaginal delivery and 73(21.3%) were instrumental vaginal delivery. Out of instrumental delivery in VBAC most of the patients delivered by ventouse 60(82.2%). Conclusion: Only one-third of the participant had vaginal birth after caesarean-section. Further longitudinal studies is needed to uncover more on the VBAC.
Outcome of post caesarian pregnancy in a tertiary care hospital in Udaipur, Rajasthan
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Background: The prevalence of caesarean section has increased due to a variety of factors such as patient choice and relative safety of the procedure. However in many cases the risk involved in LSCS is still present.Methods: The present study was designed to evaluate the outcome in cases where VBAC or TOLAC were used for the second pregnancy in a previous LSCS case. The study employed a sample of 60 subjects who were equally divided in two groups who were subjected to elective cesarian and TOLAC.Results: The results showed that TOLAC did have a better outcome as compared to repeat cesarian in context of maternal and foetal factors.Conclusions: The practice of TOLAC must be tried as an alternative and can be a viable option for uncomplicated post cesarian deliveries.
journal of medical science and clinical research, 2017
Background: Repeat caesarean section and planned vaginal birth after caesarean section are both associated with benefits and harms. Methods: Prospective data was recorded on management practices, associated complications, morbidity and mortality on 15664 consecutive cases of previous cesarean section reporting at 30 medical colleges/teaching hospitals for delivery. Results: A total of 4035 (25.8%) women out of the 15664 women with a previous cesarean section underwent a trial of labor (TOL). Of these, 2513 (62.0%) had a successful trial of labor (S-TOL) while the rest required an emergency repeat cesarean section. The overall maternal morbidity was 2.3%and 34.0% in women with S-TOL and failed trial of labor (F-TOL) respectively. Blood loss more than 1000ml was seen in 20.6% of cases with F-TOL where as for S-TOL it was 0.3%, blood transfusion was 7.0% in F-TOL where as it was 0.8% in S-TOL, dehiscence of scar in F-TOL was 5.4% as compared to 0.2% in S-TOL, post-operative complication/delivery were seen in 6.8% cases in F-TOL where as in S-TOL it was 0.4%, uterine rupture was 0.7% in F-TOL as compared to 0.1% in S-TOL and was statistically significant. Maternal death was seen in 4 (0.3%) cases of F-TOL as compared to 6 (0.2%) cases in S-TOL (p=0.45) and the difference was not significant. There were 27 (1.8%) child deaths who born after F-TOL as compared to 65 (2.6%) born after S-TOL which was highly significant (P=0.00). Conclusions: Women who experience failed trial of labor have higher risk of morbidity as compared to those with a successful trial of labor. More accurate prediction for safe, successful vaginal birth after cesarean delivery is needed.
The Outcome of Vaginal Birth After Caesarean Section (VBAC): A Descriptive Study
Medicine Today, 2013
The study, conducted in the tertiary care hospital of Dhaka Bangladesh, describes the outcome of vaginal birth after caesarean section (VBAC) in women with a previous caesarean. A prospective study was carried out from 1st January 2007 to 31st December, 2007 on 126 women with one prior lower segment cesarean section (LSCS) for a nonrecurrent cause. All unbooked women and those with estimated fetal weight more than 3.5 kg, breech presentation, history of postoperative wound infection after previous LSCS, anemia (Hb < 10 gm%), pregnancy induced hypertension, diabetes, heart disease, renal disease, cephalopevic disproportion abnormal presentation and placenta praevia were excluded from the study. An informed consent was taken for allowing a trial of vaginal delivery. Spontaneous onset of labor was awaited up to 41 weeks. Induction of labor was considered only in highly selected cases. Labor was constantly supervised by competent staff and meticulously monitored by cardiotocography (...
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2014
Background: Objective of current study was to study the outcome of trial of vaginal birth after Previous Cesarean Section (PCS) and indications for emergency repeat cesarean section at teaching hospitals in India. Methods: Prospective data was recorded on management practices, associated complications and mortality for a period of 8 months in 2005-2006 at 30 medical colleges/teaching hospitals for delivery. Results: A total of 155863 deliveries occurred during the study duration, there were 28.1% (n=43824) cesarean section and (10.1%) (n=15664) were the number of previous cesarean section. In 84% (n=13151) had repeat cesarean delivery and 2513 (16%) delivered vaginally. A trial of labor was planned in 4035 (25.8%) women. The success rate of VBAC was 62.3% with 2513 women had successful vaginal delivery and 1522 (37.7%) delivered by emergency repeat cesarean section. Major indication of emergency cesarean section was CPD (52.9%), foetal distress (25.8%), severe PIH/eclampsia (5.0%), previous 2 CS (0.7%), APH (1.4%) and others (2.7%). In majority, surgical technique was conventional and in 3.7% the Misgav-Ladach technique was used. Scar dehiscence and surgical complications were observed in 5.4% and 4.0% of cases respectively. Blood transfusion was given in 7.0% and post-operative complications were seen in 6.8%. Perinatal and maternal mortality was 18.0/1000 and 257/100000 deliveries respectively. Conclusions: Safety in childbirth for women with prior cesarean is a major public health concern. Repeat caesarean section and planned vaginal birth after cesarean section are both associated with benefits and harms and correct management represents one of the most significant and challenging issues in obstetric practice.
Outcome in women with previous caesarean section in a secondary care hospital in rural South India
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2016
Background: Caesarean section has become increasingly the common method of delivery. From 1980 to 2001 the rate in UK has increased from 9% to 21% of all births. The aim of the study was to find out the outcome of delivery in women with previous cesarean section, the mode of delivery, maternal and fetal outcome of labour and various factors which influence the mode of delivery. Methods: 150 women with one previous caesarean section who attended the antenatal clinic and fit the inclusion criteria were enrolled in the study. Results: Success rate of VBAC was 30.5% among those included in trial of labour after caesarean section (TOLAC). 60.7% of the enrolled women underwent elective repeat caesarean section of which 54.9% were at the patients' request. Favorable Bishop's score (p= 0.0002) and previous cesarean section for breech (p=0.191) are positively associated with VBAC. Incidence of maternal complications in the study was 10.67% and 2.5% babies had an Apgar <7 at 5 minutes. There was no maternal or neonatal mortality. Conclusions: The VBAC rate in the study is 30.5% in carefully selected patients for trial of scar with the existing litigation pressure. TOLAC can be judiciously implemented in carefully chosen patients even in rural health setting equipped with required facilities. Patient's participation in the decision making has brought down the VBAC rate which is reflected by the increased repeat elective cesarean section done at patients' request (54.9%). Factors such as prior vaginal delivery, favorability of the cervix, indication of previous cesarean section, onset of labour and birth weight are highly significant in deciding the success of VBAC and can be used to improve VBAC rates in practice.
Success rate of vaginal birth after cesarean section in Kerbala maternity hospital
Success rate of vaginal birth after cesarean section in Kerbala maternity hospital, 2018
Objectives To estimate the success rate of vaginal births after cesarean (VBAC) section and to identify its associated factors. Methods A cross-sectional study of a retrospective data from Holly Karbala Maternity Hospital. In this study, 3000 case sheets were collected randomly during the period from October 2016 to August 2017. From those selected patients, 530 pregnant women with a prior lower transverse cesarean section were selected for the study. Patients with a singleton term pregnancy, vertex presentation, with no medical illnesses and opt to deliver by vaginal delivery were included. Patient's information was analyzed regarding type of labor in relation to certain factors. Results A total of 347 cases were included in the research. With a mean age and SD of 30.62 ± 5.98 years. Success rate for VBAC was 73%. The predicted probability of VBAC was significantly higher in those who had a previous successful trial of labor with a success rate of 78.5% than that who did not have previous vaginal delivery 56.1%. The success rate was significantly associated with older maternal age, increase parity and lower neonatal birth weight. Conclusion The VBAC had high success rate, and the choice trial of labor after cesarean should be supported and chosen whenever it is possible over the choice of conducting second cesarean section. The success rate was positively associated with history of previous vaginal labor, older maternal age, higher parity and lower neonatal birth weight.
A Study of Vaginal Birth After Caesarean
Journal of Evolution of medical and Dental Sciences, 2015
OBJECTIVE: To evaluate the efficacy and safety of attempted VBAC with a view to decrease the incidence of caesarean section. METHODS: A prospective study is carried out on women with one previous LSCS for a non-recurrent cause attending ANC & labour room of RIMS for 2 years from 1st Aug 2007 to 31st July 2009. RESULTS: 100 eligible PCS women agreed to undergo trial of labour. Of these 50 delivered vaginally and the remaining 50 had to undergo emergency repeat caesarean section due to fetal distress, scar tenderness or non-progress of labour resulting in a VBAC rate of 50%. CONCLUSION: A trial of labour in cases of previous caesarean section is the way to reduce the overall caesarean section rate. Physicians need to discuss the risks and benefits of VBAC following trial of labour or elective repeat caesarean section with patients and patients’ choices must be considered.