Trial of Labor after Cesarean (TOLAC) for Vaginal Birth after Previous Cesarean Section (VBAC) Versus Repeat Cesarean Section; A Review

Objective To investigate the characteristics of labor in Chinese women who successfully have vaginal birth after cesarean section (VBAC). Methods A retrospective cohort study was conducted in a hospital with 1000 beds between January 1 2015 and December 31 2017. A total 657 parturients with VBAC were selected. Women were divided into two groups according to previous cesarean section with or without trial of labor. Labor curves were analyzed and interval-censored regression was used to estimate the duration of labor. Results The 95th percentile for the first stage of labor in VBAC was 13.03 hours, and labor accelerated after 4 cm of cervical dilation in both groups. The dilation rate in the trial of labor group was superior to that in the non-trial of labor group at 6–10 cm of dilation. After 6 cm, labor accelerated much faster in the trial of labor group than in the non-trial of labor group. Conclusions Management of labor in parturients with VBAC whose cervical dilation is >6 cm should be treated differently according to previous cesarean section with or without trial of labor. If there is trial of labor in a previous delivery, the duration of labor should be shortened.

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Trail of labor versus elective repeat cesarean section: a comparison of morbidity and mortality at tertiary care teaching hospitals in India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20184492 ◽

2018 ◽

Vol 7 (11) ◽

pp. 4476

Author(s):

Balwan Singh Dhillon ◽

Nomita Chandhiok ◽

M. Vishnu Vardhana Rao

Keyword(s):

Cesarean Section ◽

Maternal Morbidity ◽

Management Practices ◽

Tertiary Care ◽

Teaching Hospitals ◽

Previous Cesarean Section ◽

Trial Of Labor ◽

Repeat Cesarean Section ◽

Elective Repeat Cesarean ◽

Previous Cesarean

Background: As cesarean birth rates continue to rise, more women are faced with the choice of planning a vaginal delivery or a repeat cesarean section after a previous cesarean section. The objective of this prospective study was to study the morbidities and mortality of women attempting a trial of labor after cesarean (TOLAC) versus elective repeat cesarean section (El-RCS).Methods: Prospective data was recorded on management practices, associated complications and morbidity & mortality for a period of 8 months on 15664 consecutive cases of previous cesarean section reporting at 30 medical colleges/ teaching hospitals for delivery.Results: A trial of labor was planned in 25.8% (4035) women and 34.5% (5399) women underwent elective repeat cesarean section and rest had emergency repeat cesarean section. Overall maternal morbidity due to any cause was 20.7% among El-RCS as compared to 14.2% in TOLAC which was statistically significant (OR: 1.57, CI: 1.41-1.76, P=0.00). Blood loss of more than 1000ml was around 8.0% among TOLAC where as in El-RCS it was 8.8% (OR: 0.89, CI: 0.77-1.94, p=0.14 not statistically significant). Blood transfusion was given in 3.7% in TOLAC where as in El-RCS it was given in 6.5% (OR: 0.56, CI: 0.45-0.68, p=0.00 highly significant). Complication like dehiscence of scar was similar in both groups. Post-operative complication were seen in 2.8% cases in TOLAC where as in El-RCS it was 5.8% (OR: 0.47, CI: 0.38-0.59, p=0.00 highly significant). Uterine rupture was 0.3% in TOLAC where as in El-RCS it was 0.7% (OR: 0.43, CI: 0.21-0.87, p=0.009 statistically significant). Maternal mortality was reported in 0.2% cases of TOLAC as compared to 0.1% cases in El-RCS (p=0.17) which was not statistically significant.Conclusions: Maternal morbidity was found to be more in elective repeat cesarean section than trial of labor after cesarean section.

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Prevalence of Repeat Cesarean Section in a Tertiary Care Hospital

Journal of Nepal Medical Association ◽

10.31729/jnma.5375 ◽

2020 ◽

Vol 58 (229) ◽

Author(s):

Jyotshna Sharma ◽

Sanjeeb Tiwari ◽

Saraswati M Padhye ◽

Bidya Mahato

Keyword(s):

Cesarean Section ◽

Teaching Hospital ◽

Vaginal Birth ◽

Care Hospital ◽

Previous Cesarean Section ◽

Vaginal Birth After Cesarean ◽

Medical College ◽

Increased Risk ◽

Repeat Cesarean Section ◽

Previous Cesarean

Introduction: Cesarean section is the surgical delivery of a baby through an incision made in the mother's abdomen and uterus. Repeat cesarean section has recently increased, partly because of concern about increased risk of uterine rupture in women attempting vaginal birth after cesarean delivery. Among the women who underwent cesarean section in their first delivery, 80-96% had a second surgical delivery. Therefore, the present study aimed to describe the prevalence of repeat cesarean section among Nepali women presented at Kathmandu Medical College and Teaching Hospital who had a previous cesarean section. Methods: This was a descriptive cross-sectional study conducted in Kathmandu Medical College and Teaching Hospital from 1st of February to 31st of May 2020. Ethical approval was taken from the Institutional Review Committee of the Kathmandu Medical College. Convenient sampling was done. All pregnant patients between gestational ages of 37-40 weeks with previous cesarean section admitted for safe confinement were included in the study. Results: Among the 104 women, who had prior cesarean section, 99 (95.19%) had second cesarean section and 5 (4.81%) had vaginal birth after cesarean. The most common indication for the first cesarean section was fetal distress 31 (29.81%) while the indication for the second cesarean section among previously cesarean section women was cephalo pelvic disproportion 39 (39.40%). Conclusions: The proportion of cesarean section in both first and subsequent delivery is quite high. This high rate may compromise the reproductive future of the women who underwent consecutive cesarean section with possible consequent complications.

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“THE WAR WHEN YOU ALREADY HAVE A SCAR” -STUDY OF DIFFICULTIES IN EXTRACTION OF BABY IN PREVIOUS CESAREAN SECTION

10.36106/ijsr/7802413 ◽

2021 ◽

pp. 68-70

Author(s):

Ashwini N Hotkar ◽

Prashanth Bhingare ◽

Srinivas Gadappa ◽

Sasireka Kuppuswami ◽

Priyanka Kesharwani

Keyword(s):

Cesarean Section ◽

Care Hospital ◽

Previous Cesarean Section ◽

Trial Of Labor ◽

Tertiary Centre ◽

Risk Pregnancy ◽

Pregnancy Status ◽

Repeat Cesarean Section ◽

Time Of Operation ◽

Previous Cesarean

Background:The study of intraoperative difculties in extraction of baby in previous cesarean section Method:This is a tertiary centre based prospective observational study conducted in the department of Obstetrics and Gynaecology, at our tertiary health Care hospital between the study period October 2018-september 2020.A total 1200 cases of patients with previous cesarean section were studied . They are divided into number of previous scar and the intraoperative surgical difculty encountered by the surgeon in delivering the baby based on the consequences of scar from previous cesarean section. Results: The incidence of repeat cesarean section being 9.4%, among which only of 38% cases were encountered with difculties in cesarean section by the surgeons in the institute. Among which 26.3% cases were encountered with Adhesions,4.2% with difculty in delivery of baby, 1.5% cases needed assistance by senior surgeon in delivering baby and 6% among that had poor perinatal outcome. Conclusions: The common clinical entity of “previous cesarean section” in subsequent pregnancies, giving a high risk pregnancy status to the reference pregnancy. The risks associated with repeat cesarean section can be reduced by many measures including-vigorous ANC surveillance to reduce the risk of primary CS, intervention by operative vaginal delivery whenever needed, giving trial of labor in cesarean section(TOLAC) with skilled monitoring, counselling of patients regarding perineal exercises in pregnancy. Most complications will be recognized at the time of operation and easily corrected either by the operating surgeon or by seeking assistance from other specialties

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