Assessment of factors individually and as a scoring system in predictive screening for VBAC in patients undergoing trial of labor after single previous cesarean section. (original) (raw)
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Objective: This study aims to determine the success of vaginal birth after cesarean section (VBAC) based on previous cesarean delivery indication. Design: Retrospective cohort study Setting: University of the Philippines - Philippine General Hospital, Department of Obstetrics and Gynecology hospital masterlist data Sample: Gravidas with a previous cesarean section within a five year period (2015 - 2019) METHODS: Maternal demographics, obstetric characteristics on admission, perinatal morbidities and maternal morbidities were recorded. Data was analyzed using Student’s t-test for continuous variables, chi-square test to compare the distribution and Z-test was used to compare success rates. Main outcome measures: The main outcome measures are TOLAC rate, VBAC rate, factors which affect success of TOLAC and VBAC, and perinatal and maternal morbidities associated with successful and failed VBAC. Results: A total of 2485 patients were included. The overall TOLAC rate was 17% (95% CI: 15.6% - 18.6%) and the VBAC rate was 9.5% (95% CI: 8.3% - 10.7%). Patients with successful VBAC are younger, had less weight and body mass index, shorter interdelivery intervals, and admitted in active phase cervical dilatation. Previous cesarean section indication did not significantly affect VBAC success. Perinatal and maternal morbidities of successful and failed VBAC did not significantly differ from one another. Conclusions: This study provided local evidence and valuable perspective in success factors which influence our counselling and eventual management of patients with a previous cesarean section.
Journal of South Asian Federation of Obstetrics and Gynaecology
Aims and objectives: To assess the prediction of a successful trial of labor after cesarean section (TOLAC) using a predictive scoring system at the time of labor. Materials and methods: The present study was a prospective cohort study. Women with one previous lower segment cesarean section (LSCS) in labor admitted to the labor room, willing for a vaginal birth after cesarean section (VBAC) were included in the study and explained about the option of TOLAC with the predictive score (integer score) and its success. The predictive validity of the VBAC score was assessed by the receiver operating curve (ROC) analysis. Results: A total of 194 women were included in the study. The proportion of successful VBAC was 43.30% in the current study. The most common indication for previous LSCS in the patients who underwent repeat LSCS was nonprogress of labor (17.53%) followed by fetal distress in 12.89%. The VBAC score had good predictive validity in predicting successful VBAC, as indicated by the area under the curve of 0.853 (95% CI 0.798 to 0.908, p value < 0.001). The sensitivity of a VBAC score of 13.5 or more in predicting successful VBAC was 83.3% (95 CI 75.36% to 91.3%) and specificity was 78.2% (95 CI 70.46% to 85.9%). Positive predictive value was 74.5% (95 CI 65.65% to 83.3%), negative predictive value was 86% (95 CI 79.2% to 92.8%), and the total diagnostic accuracy was 80.4% (95 CI 74.83% to 86%). After controlling the effect of other values in the equation, the history of previous vaginal birth and high modified Bishop score were the factors that were significantly associated with successful VBAC. The symptomatic uterine rupture occurred in 0.1% of women who underwent TOLAC. No perinatal morbidity or mortality is seen. Conclusion: Vaginal birth after cesarean section score has demonstrated as a good predictive validity in predicting successful VBAC. TOLAC should be encouraged in most of the women who are willing to attempt it, provided no obstetric contraindication exists.
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.
Journal of obstetrics and gynaecology of India, 2014
To study the various predictors of success for vaginal birth after cesarean (VBAC) and to study the maternal and fetal outcomes in them and their comparison with control group. This prospective observational study included 100 women with previous cesarean section in the study group and 100 primigravidas in the control group. Various predictors for success of VBAC were analyzed and maternal and fetal outcomes were compared with the control group using student t test, Pearson χ (2) test, and Mann-Whitney U test. Of 100 women with prior cesarean Sect. 65 had successful trial of labor, while 35 underwent a repeat cesarean section. Maternal complications in the previous CS group were 15 % as compared to only 2 % in the control group (p < 0.001). Maternal pre-pregnancy BMI, non-recurring indications of previous cesarean section, good Bishop's score at the time of admission, spontaneous onset of labor, and neonatal birth weight were significantly related to high chances of success o...
Factors predicting Success of Vaginal Birth after Cesarean Section
Journal of SAFOG
Aim: The aim of this article is to study the various factors that can predict the success of vaginal birth after cesarean (VBAC) section. Materials and methods: A retrospective cohort study of deliveries was conducted from 1 January 2014 to 31 December 2014 by the Department of Obstetrics and Gynecology in our hospital. Patients with previous low transverse cesarean section who had undergone a trial of labor were identified. Maternal inpatient and prenatal records were reviewed in all eligible subjects. During labor, uterine activity and fetal heart rate were monitored. When indicated, oxytocin or prostaglandin E2 was used for induction of labor according to Bishop score. Emergency cesarean delivery was considered in cases with the appearance of scar tenderness, fetal distress, nonprogress of labor, and deep transverse arrest. Results: A total of 200 women were eligible for VBAC, but after written informed consent, 131 (65.5%) subjects were given trial of labor at term after one prior cesarean delivery among 3,604 deliveries while 69 (34.5%) subjects opted for elective repeat cesarean section. The overall VBAC success rate was 63.3% (76 of 120) in our study. History of spontaneous labor (p = 0.042) and history of previous vaginal delivery (p = 0.038) were found to be significantly associated with increased chance of success of VBAC, and lesser interdelivery interval was not found to be associated with decreased success rate (p = 0.096). Neither indication of previous cesarean nor birth weight of newborn (>3 kg) was found to be related to the success of VBAC. Conclusion: Vaginal birth after cesarean section is a safe practice as long as it is offered with a proper selection of candidates with factors having a high success rate. Physicians need to be aware of factors having a good outcome before counseling mothers so that failure rates decrease and successful VBAC is increased.
Open Journal of Obstetrics and Gynecology, 2023
Background: Trial of labor after cesarean delivery (TOLAC) has long been accepted as a safe option for women with previous cesarean delivery. Previous efforts have been exerted in trials to predict the success rates of TOLAC according to specific parameters related to previous cesarean section and before TOLAC. We aimed to investigate the different indications of previous cesarean delivery as independent predictors for successful vaginal birth. Methods: A retrospective study was conducted in Armed Forces Hospitals of the Southern Region between December 15, 2019, and July 1, 2020. The included 566 patients with previous cesarean section who were willing to undergo a trial of labor were divided into two groups according to the success of vaginal birth (VBAC). Results: The nonrecurring indications for previous cesarean delivery were higher in the successful group (fetal distress 54.7% vs 41.1%, malpresentation 26% vs 21.4%, multifetal pregnancy 3.8% vs 2.7%). Additionally, the successful VBAC group had a significantly higher percentage of previous successful VBAC (47.7% vs 21.9%) and prior vaginal deliveries (58.5% vs 44.2%) and less coincidence of medical disorders and meconium-stained liquor (18.1% vs 26.3% and 3.2% vs 8.2%, respectively) than the unsuccessful group. Conclusion: During counseling regarding trial of labor after cesarean section, indications for previous cesarean section not related to arrest of labor can predict higher success of VBAC. Moreover, previous successful vaginal delivery or VBAC improves the success rates.
Prognostic factors for successful vaginal birth after cesarean sectionAnalysis of 162 cases
… of Obstetrics and Gynecology of India, 2010
Objective : To analyze the success rate of VBAC (Vaginal birth after cesarean section) with reference to various factors and derive simple and easily usable prognostic factors to predict successful VBAC. Methods (Study Design) In this retrospective observational study, 162 women who had undergone successful trial of labor were analyzed to study the factors which contributed to successful trial of labor over a study period of one year. Maternal age, prior antenatal visits, prior obstetric history, neonatal weight and interconceptional period were studied with reference to outcome of VBAC. Success of VBAC when compared with prior indication for CS was studied. The role of instrumental deliveries for VBAC was analyzed. Maternal and perinatal mortality and morbidity were assessed. Chi square test was used to analyze the significance of each factor. Results Success rate of VBAC was 75%. Maternal age, prior antenatal care, prior vaginal delivery, neonatal weight and interconceptional period were all statistically significant predictors (P<0.001) of successful VBAC. Instrumental deliveries were helpful in successful VBAC and can be used prophylactically to cut short second stage. VBAC had no adverse maternal or perinatal outcome. Conclusion: VBAC can be successfully tried in all women with prior cesarean section by careful selection and employing simple predictive factors.
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.
Journal of Clinical Obstetrics & Gynecology, 2020
Our primary objective is to evaluate the short-term maternal and perinatal results associated with the mode of delivery after cesarean section (CS). A second objective is to investigate the factors governing the success of trial of labor after cesarean (TOLAC). Material and Methods: In this retrospective cohort study, 126 singleton cephalic deliveries of women who had a history of one CS delivery were analyzed. The patients were divided into two groups: those who underwent TOLAC (n=31) and those who underwent elective repeat cesarean section (n=95). Delivery data, demographics, obstetric and medical history, intrapartum events, and maternal and perinatal outcomes were assessed. Results: The rate of successful vaginal birth after cesarean among the women who chose TOLAC was 64.5%. The groups were similar to each other with regard to maternal and perinatal complications. According to the current pregnancy characteristics of the patients with successful and failed vaginal delivery attempts; there were statistically significant differences between the groups in terms of Bishop scores and birth weights. The Bishop scores were higher in the successful TOLAC group (3.5 vs. 1; p=0.001). However, the birth weights were lower in the successful TOLAC group (3393±395 vs. 3708±430; p=0.049). The rate of spontaneous labor was higher in the successful TOLAC group, although it did not reach statistical significance. Conclusion: TOLAC is a farily safe procedure for selected pregnant women with one previous cesarean sections. It should be offered to all suitable pregnant women in order to reduce high CS rate and prevent complication associated with higher order repeat cesarean.