Study of comparison of maternal and fetal outcome of elective repeat caesarean versus vaginal birth in women after one prior lower segment caesarean section

Background: Globally, high rates of caesarean section (CS) are an issue of public health concern. For women who have had a previous caesarean, choices for mode of birth in their next pregnancy are either a trial of vaginal birth after caesarean (TOLAC) or an elective repeat caesarean delivery (ERCD). Both ERCD and TOLAC have benefits and risks associated.Methods: A prospective comparative study was conducted in the Department of Obstetrics and Gynecology at SDM college of medical science and hospital, Dharwad, Karnataka, India. The study included 80 women with one previous lower segment caesarean section over a period of 1 year. A 40 women underwent TOLAC and 40 women had a repeat caesarean section. The maternal and fetal outcomes in trial of labour after caesarean delivery and repeat caesarean delivery were compared.Results: In this study maternal morbidity was more common in ERCD group than in the TOLAC group. Neonatal outcome was the same in both the study groups. Conclusions: In our study the TOLAC success rate was 70-80%, pregnant woman with one previous lower segment Caesarean section should be given the option of TOLAC, unless contraindicated.

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ABNORMAL CARDIOTOCOGRAPHY;

The Professional Medical Journal ◽

10.29309/tpmj/2014.21.06.2247 ◽

2014 ◽

Vol 21 (06) ◽

pp. 1087-1091

Author(s):

Saima Perveen ◽

Farrukh Naheed ◽

Mussarat Sultana ◽

Azra Sultana

Keyword(s):

Caesarean Section ◽

Vaginal Delivery ◽

Apgar Score ◽

Case Series ◽

Fetal Distress ◽

Lateral Position ◽

Fetal Outcome ◽

Lower Segment ◽

Lower Segment Caesarean Section ◽

Case Series Study

Objective: To observe the effect of abnormal Cardiotocography to delivery interval on perinatal outcome in terms of Apgar score. Study design: Descriptive case series study. Place and duration of study: Baqai Medical University department of obstetrics and gynecology Fatima Hospital Karachi from Jan 2011 to July 2011. Material and method: One hundred patients were registered who had pathological Cardiotocography. Bishop’s score was noted and decision to deliver the patient was made according to the abnormality, and bishop’s score. If bishop’s score was good and vaginal delivery was imminent, then her second stage was shortened by operative vaginal delivery. Fetal distress was managed by left lateral position, O2 inhalation and hydration. If delivery was not imminent then decision of urgent LSCS was made, meanwhile fetal distress was managed. Decision – delivery interval was recorded, and fetal outcome was noted in terms of Apgar score and resuscitation needed. Results: During this period one hundred pregnant women at term had pathological CTG for which they were delivered urgently. Among them 12% of parturients were delivered within 30 min ,68% delivered within 30-60 min , 12% delivered in 60-90 min and only 8% were delivered in 90-120 min. Seventy four (74%) of parturients were delivered by emergency lower segment caesarean section and 26% of parturients were delivered by instrumental vaginal delivery. Fetal outcome in terms of 1 min Apgar score ,38% of neonates had Apgar score of <7 ,46% had >7 and 16% had Apgar score of <5. This group of neonates required resuscitation and 5 min Apgar was good. No neonate was admitted in Neonatal unit. Conclusions: In this study it is concluded that with fetal heart rate abnormality, if fetus is delivered within 60 min, it is not associated with poor fetal and neonatal outcome, provided fetal distress is managed while preparing for emergency lower segment caesarean section.

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Posterior Uterine Rupture Causing Fetal Expulsion into the Abdominal Cavity: A Rare Case of Neonatal Survival

Case Reports in Obstetrics and Gynecology ◽

10.1155/2011/426127 ◽

2011 ◽

Vol 2011 ◽

pp. 1-3 ◽

Cited By ~ 4

Author(s):

K. Navaratnam ◽

P. Ulaganathan ◽

M. A. Akhtar ◽

S. D. Sharma ◽

M. G. Davies

Keyword(s):

Caesarean Section ◽

Uterine Rupture ◽

Abdominal Cavity ◽

Fetal Outcome ◽

Emergency Caesarean Section ◽

Vaginal Birth ◽

Lower Segment ◽

Healthy Baby ◽

Case Presentation ◽

Vaginal Birth After Caesarean

Introduction. Uterine rupture is a potentially catastrophic complication of vaginal birth after caesarean section. We describe the sixth case of posterior uterine rupture, with intact lower segment scar, and the first neonatal survival after expulsion into the abdominal cavity with posterior rupture.Case Presentation. A multiparous woman underwent prostaglandin induction of labour for postmaturity, after one previous caesarean section. Emergency caesarean section for bradycardia revealed a complete posterior uterine rupture, with fetal and placental expulsion. Upon delivery, the baby required inflation breaths only. The patient required a subtotal hysterectomy but returned home on day 5 postnatally with her healthy baby.Discussion. Vaginal birth after caesarean section constitutes a trial of labour, and the obstetrician must be reactive to labour events. Posterior uterine rupture is extremely rare and may occur without conventional signs. Good maternal and fetal outcome is possible with a prompt, coordinated team response.

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Safety of vaginal birth after single previous lower segment caesarean: a retrospective analysis of 200 cases

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20182393 ◽

2018 ◽

Vol 7 (7) ◽

pp. 2596

Author(s):

Renu Jain

Keyword(s):

Caesarean Section ◽

Retrospective Analysis ◽

Caesarean Delivery ◽

Admission Rate ◽

Active Phase ◽

Vaginal Birth ◽

Lower Segment ◽

Lower Segment Caesarean Section ◽

Increased Risk ◽

Vaginal Birth After Caesarean

Background: Vaginal birth after Caesarean delivery (VBAC) has long been proposed as a viable measure to reduce overall Caesarean delivery rates. The objective of present study was to assess predictive factors and to study outcome of pregnancy in women with one previous lower segment caesarean section underwent trial of scar, in author’s hospital setting.Methods: This retrospective analysis of 200 pregnant women with one previous lower segment caesarean section underwent trial of scar, was carried out over a period of one year, in department of Obstetrics and Gynaecology, Gajra Raja Medical College, Gwalior (M.P.). The maternal and neonatal data and data concerning the course of delivery were reviewed and subjected to statistical analysis.Results: The success rate of VBAC was 36%. Young maternal age, gestational age <40 weeks, neonate birth weight 2.5-3 kg, admission in active phase of labor, previous caesarean for malpresentation, meconium stained liquor and fetal distress, were associated with successful VBAC. The commonest indication of repeat caesarean section was non-progress of labor in 34.37% women. Admission rate to neonatal intensive care unit was less in VBAC (2.77%) than in repeat caesarean section group (7.03%). There was one case of uterine rupture. There were 3 perinatal deaths and no maternal deaths.Conclusions: Women with a prior caesarean section are at increased risk of subsequent caesarean. Vaginal birth after caesarean should be encouraged in selected cases to reduce the risks of repeated caesarean sections. However, in the event of a failed trial, there is a definite increase in neonatal and maternal morbidity which is also reflected in our study.

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Comparison of Expectant Management Versus Induction of Labour at 40 Weeks on Successful Vaginal Birth Rate in Women with a Previous Caesarean Section: A Randomized Controlled Trial and A Pilot Study.

10.22541/au.161159299.97475729/v1 ◽

2021 ◽

Author(s):

Rajalakshmi K ◽

Gowri Dorairajan ◽

Swetha Kumar ◽

Palnivel Chinnakali

Keyword(s):

Caesarean Section ◽

Birth Rate ◽

Controlled Trial ◽

Expectant Management ◽

Vaginal Birth ◽

Lower Segment ◽

Lower Segment Caesarean Section ◽

Oxytocin Infusion ◽

Low Risk Women ◽

Vaginal Birth After Caesarean

Objective: to compare the vaginal birth rate in women with previous one lower segment caesarean section when induced at 40 weeks compared to expectant management till 41 weeks. Design: A randomized controlled trial Setting: Department of Obstetrics and Gynaecology, JIPMER, a tertiary care teaching institution in the south of India. Population or Sample: Low-risk women with previous one single lower segment caesarean section with a singleton foetus in vertex presentation and eligible for a trial of labour (TOLAC) at 40 weeks gestation. Methods: Block randomization to two groups of thirty each. The induction group was induced at 40 weeks with low dose oxytocin infusion or ripening with a single application of a single balloon Foley catheter followed by oxytocin infusion 24 hours later. The expectant group was managed in the hospital with maternal and foetal surveillance and induced at 41 weeks if they had not delivered by then. Main Outcome Measures: Vaginal birth after caesarean section (VBAC). Results: The demography and pregnancy variables were comparable in the two groups. Twenty out of thirty women (66.67%) had a successful vaginal birth after caesarean section in the induction group compared to ten out of 30 (33.33%) in the expectant group. This difference was significant (RR 2.0, 95% CI: 1.13-3.52; P=0.016) Conclusions: Among low-risk women with previous one lower segment caesarean section willing and eligible for TOLAC, the successful VBAC rate is significantly higher among those induced at 40 weeks compared to those managed expectantly till 41 weeks.

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