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

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.

scholarly journals 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.

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.

scholarly journals Indications and rate of caesarean delivery at tertiary care hospital: a retrospective study

2017 ◽  
Vol 6 (10) ◽  
pp. 4367
Author(s):  
Reena Sharma ◽  
Poojan Dogra
Keyword(s):  
Retrospective Study ◽  
Caesarean Section ◽  
Caesarean Delivery ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Lower Segment ◽  
Lower Segment Caesarean Section ◽  
Number Of Patients ◽  
Increasing Trend

Background: Worldwide there has been an increase in the rate of caesarean delivery due to multiple factors. Objective of the study was to assess the prevalence and different indications of caesarean section in this institute.Methods: The aim of the study is to analyse the rates and indications of lower segment caesarean section (LSCS) in our institution. We conducted a retrospective study over a period of six months; 1st September 2016 to 1st March 2017 at SLBSGMC Mandi at Nerchowk. Total number of patients who delivered in our hospital during the defined study period was recorded and a statistical analysis of various parameters was done.Results: The total number of women delivered over the study period was 2075, out of which caesarean sections (CS) were 473. The overall CS rate calculated was 22.8%. Previous LSCS was the leading indication to the CS rate.Conclusions: Routine obstetric audits should be done to analyse the various indications of emergency and elective caesarean sections so that protocols and guidelines can be implemented to curtail the increasing trend of caesarean delivery.

scholarly journals Pregnancy Outcome in Women with One Previous Caesarean Delivery - A Prospective Longitudinal Study in a Peripheral Medical College of West Bengal

2021 ◽  
Vol 8 (21) ◽  
pp. 1608-1613
Author(s):  
Saheli Chandra ◽  
Anjan Dasgupta ◽  
Pradip Kumar Saha ◽  
Kamal Kumar Dash ◽  
Abirbhab Pal ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Vaginal Delivery ◽  
Caesarean Delivery ◽  
West Bengal ◽  
Vaginal Birth ◽  
Safe Procedure ◽  
Prospective Longitudinal Study ◽  
Medical College ◽  
Prospective Longitudinal ◽  
Vaginal Birth After Caesarean

BACKGROUND Pregnancy with one prior Caesarean section (CS) constitutes a high-risk group with associated medical and legal implications. The dictum ‘once a Caesarean always a Caesarean’ has now judiciously been replaced with ‘once a Caesarean, trial of labour after selection’ because low transverse uterine incision has much lesser chance of scar rupture. Though vaginal birth after Caesarean (VBAC) or trial of scar (TOS) brings a significant change in modern obstetric practice in terms of lower maternal and perinatal morbidities, apprehension of accidental scar rupture during trial of labour with its undesirable consequences still prevents a good number of obstetricians adopting this process. The purpose of the study was to determine the outcome of pregnancy in relation to mode of delivery, i.e., either elective repeat Caesarean section (ERCS) or vaginal birth after Caesarean (VBAC) with maternal and perinatal complications in each mode. METHODS A hospital based prospective, longitudinal, and observational study of 300 pregnant women with previous one Caesarean delivery attended labour emergency or out-patient department (OPD) at Midnapore Medical College of West Bengal, was carried out, approved by the institutional ethical committee. Gestational age < 37 weeks and > 42 weeks and h\o previous uterine surgery like myomectomy, hysterotomy, classical CS were excluded from the study. Data collected was analysed using statistical package for the social sciences (SPSS) software version 20. Descriptive statistics were used to analyse the continuous and categorical data and expressed in the form of mean and percentage whereas proportions were analysed using chi-square test. A P - value ≤ 0.05 was considered statistically significant. RESULTS Out of 300 pregnancies, 140 subjects were given trial of labour (TOL). Of which 89 subjects (63.6 %) had successful VBAC and 51 subjects (36.4 %) had repeat Caesarean sections. Among 211 subjects of repeat Caesarean section, 53 subjects (25.12 %) had indicated for scar tenderness and 73 subjects (34.59 %) had elective repeat Caesarean section (ERCS) due to protracted or arrested cervical dilatation. Those having previous vaginal delivery (VD), had more incidences of VBAC in present pregnancy than those who had no previous VD (P ≤ 0.005); Maternal morbidity (33.65 % ERCS versus 10.11 % VD group, P ≤ 0.05) and neonatal morbidity (12.3 % ERCS versus 2.46% VD group, P ≤ 0.05) was significantly higher in ERCS group. CONCLUSIONS Trial of labour (TOL) should be given in well-equipped hospital. In carefully selected cases, it is a safe procedure and often rewarding, thus incidence of repeat CS can be reduced. Those who had a history of vaginal delivery, VBAC often successful. KEYWORDS VBAC, Trial of Scar, Elective Repeat Caesarean Section, Trial of Labour

scholarly journals A comparative study of maternal and fetal outcome in trial of labour after caesarean delivery and elective repeat caesarean delivery

2019 ◽  
Vol 8 (3) ◽  
pp. 1171
Author(s):  
Asha Neravi ◽  
Namrata Kulkarni ◽  
M. Usha Brindhini ◽  
V. Udayashree
Keyword(s):  
Caesarean Section ◽  
Comparative Study ◽  
Caesarean Delivery ◽  
Medical Science ◽  
Study Groups ◽  
Fetal Outcome ◽  
Health Concern ◽  
Lower Segment ◽  
Lower Segment Caesarean Section ◽  
Mode Of Birth

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. 

scholarly journals Risk of obstetric anal sphincter injury among women who birth vaginally after a prior caesarean section: A state-wide cohort study

2021 ◽  
Author(s):  
Jessica Uebergang ◽  
Richard Hiscock ◽  
Roxanne Hastie ◽  
Anna Middleton ◽  
Natasha Pritchard ◽  
...  
Keyword(s):  
Cohort Study ◽  
Caesarean Section ◽  
Anal Sphincter ◽  
Vaginal Birth ◽  
Obstetric Anal Sphincter Injury ◽  
Sphincter Injury ◽  
Anal Sphincter Injury ◽  
Increased Risk ◽  
Primiparous Women ◽  
Vaginal Birth After Caesarean

Objective: Vaginal birth after caesarean (VBAC) has been suggested to be associated with an increased risk of obstetric anal sphincter injury (compared with primiparous women who birth vaginally). However, prior studies have been small, or used outdated methodology. We set out to validate whether the risk of obstetric anal sphincter injury among women having their first VBAC is greater than that among primiparous women having a vaginal birth. Design: State-wide retrospective cohort study. Setting: Victoria, Australia. Population: All births (455,000) between 2009-2014. Methods: The risk of severe perineal injury between first vaginal birth and first vaginal birth after previous caesarean section was compared, after adjustment for potential confounding variables. Covariates were examined using logistic regression for categorical data and Wilcoxon rank-sum test for continuous data. Missing data were handled using multiple imputation; the analysis was performed using regression adjustment and Stata v16 multiple imputation and teffects suites. Results: Women having a VBAC (n=5,429) were significantly more likely than primiparous women (n=123,353) to sustain a 3rd or 4th degree tear during vaginal birth (7.1 vs 5.7%, p<0.001). After adjustment for mode of birth, body mass index, maternal age, infant birthweight, episiotomy and epidural, there was a 21% increased risk of severe perineal injury (relative risk 1.21 (95%CI 1.07 – 1.38)). Conclusions: Women having their first vaginal birth after caesarean section have a significant increased risk of sustaining a 3rd or 4th degree tear, compared with primiparous women having a vaginal birth. Patient counselling and professional guidelines should reflect this increased risk.

scholarly journals Outcome of Women with Previous Cesaerian Section At A Tertiary Care Hospital in Eastern Nepal

2015 ◽  
Vol 12 (1) ◽  
pp. 18-23
Author(s):  
Ajay Agrawal ◽  
S Chhetri ◽  
A Thakur ◽  
S Agrawal ◽  
P Basnet
Keyword(s):  
Caesarean Section ◽  
Pregnant Women ◽  
Perinatal Outcome ◽  
Caesarean Delivery ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Vaginal Birth ◽  
Care Hospital ◽  
Previous Caesarean Section ◽  
Vaginal Birth After Caesarean

Background: Pregnant women with previous caesarean section are increasing due to the liberal use of caesarean section in first pregnancy due to multifactorial reason. The risks, benefits, and relative safety of vaginal birth after caesarean (VBAC) have been subject of interest for well over 100 years. Thus mutual understanding between the treating obstetrician and patient herself is a core towards achieving good maternal and perinatal outcome considering all the risk and benefit in women with previous caesarean section. Objective: The aim was to analyze the maternal and perinatal outcome in pregnant women with previous caesarean section. Methods: In this prospective observational study, 300 women with singleton pregnancy in cephalic presentation with previous one lower segment caesarean section (LSCS) having inter pregnancy interval ≥ 18 months presenting at ≥ 37-41 week period of gestation admitted for delivery were enrolled and various maternal and perinatal outcome were noted. Results: Caesarean delivery rate during the study period was 26.95%. Eighty percent of eligible women opted for trial of labor. Successful vaginal birth after caesarean section was 29%. Elective repeat caesarean delivery was 19.66%. The rate of failed VBAC was 51%. Failed VBAC increased with increasing weight of baby. There was no difference in mean birth weight among patient who had successful VBAC, who refused VBAC and who had failed VBAC. Mode of delivery had no significant effect on the number of neonatal intensive care unit admission and number of still births.  DOI: http://dx.doi.org/10.3126/hren.v12i1.11980Health Renaissance 2014;12(1):18-23

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