Outcomes of induction in trial of labor after cesarean delivery

Background: The objective of this study is to evaluate the outcomes of induction of labor in women attempting trial of labor after cesarean delivery and to compare maternal and neonatal morbidity and mortality in women who were induced to those delivering spontaneously.Methods: The prospective study was carried out in the Department of Obstetrics and Gynecology in collaboration with the Neonatal Section, Department of Pediatrics at J.N. Medical College and Hospital, AMU Aligarh. The sample included 280 women with one previous cesarean section, of whom 130 women underwent induction of labor (study group) and 150 were admitted with spontaneous onset of labor. Prostaglandin gel and intracervical Foley’s were used for cervical ripening in the study group. Indication of cesarean section, mode of delivery, maternal and neonatal outcome were studied in between groups.Results: Overall rate of vaginal delivery after cesarean section was 45.3% and 56% in both study and control group respectively. The rate of cesarean section were higher in women who were induced and having unfavorable cervix. Maternal and neonatal morbidity were not significantly higher as compared in both groups, however one case of scar rupture was found in study group.Conclusions: Induction of labor in women with previous cesarean section had higher rates of cesarean section however it does not adversely affect neonatal and maternal morbidity. Overall vaginal birth is safe and effective in women with previous cesarean section by prostaglandin gel or intracervical Foley’s. Authors cautiously suggest, induction of labor should be considered in preselected patient with strict monitoring.

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Effect of shared decision making on mode of delivery and decisional conflict and regret in pregnant women with previous cesarean section: a randomized clinical trial

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03615-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Fatemeh Hadizadeh-Talasaz ◽

Faezeh Ghoreyshi ◽

Fatemeh Mohammadzadeh ◽

Roghaieh Rahmani

Keyword(s):

Decision Making ◽

Cesarean Section ◽

Pregnant Women ◽

Shared Decision Making ◽

Mode Of Delivery ◽

Decisional Conflict ◽

Control Group ◽

Shared Decision ◽

Previous Cesarean Section ◽

Previous Cesarean

Abstract Background The promotion of vaginal birth after cesarean section (VBAC) is the best method for the reduction of repeated cesarean sections. Nonetheless, the decisional conflict which often results from inadequate patient involvement in decision making, may lead to delayed decision making and regret about the choices that were made. The present study aimed to determine the effect of shared decision making on the mode of delivery and decisional conflict and regret in pregnant women with previous cesarean section. Methods This randomized clinical trial was conducted on 78 pregnant women with a previous cesarean section referring to community health centers in Torbat-e Jam, Iran, in 2019. They were randomly assigned to two groups of intervention and control. During weeks 24-30 of pregnancy, the Decisional Conflict Scale (DCS) was completed by pregnant mothers. Apart from the routine care, the experimental group received a counseling session which was held based on the three-talk model of shared decision making. This session was moderated by a midwife; moreover, a complementary counseling session was administered by a gynecologist. During weeks 35–37 of pregnancy, DCS was completed, and the Decision Regret Scale (DRS) was filled out for both groups at the 8th weeks postpartum and they were asked about the mode of delivery. Data were analyzed in SPSS software (version 19) using the Mann-Whitney, Chi-squared and Fisher’s exact tests. p-value less than 0.05 was considered statistically significant. Results After the intervention, the decisional conflict score was significantly lower in the shared decision making (SDM) group, compared to that in the control group (14.90 ± 9.65 vs. 25.41 ± 13.38; P < 0.001). Moreover, in the SDM group, the rate of vaginal birth was significantly higher than that in the control group (P < 0.001). Two month after the delivery, the mean score of decision regret was lower in the SDM group, in comparison to that in the control group (15.67 ± 23.37 vs. 27. 30± 26.75; P = 0.007). Conclusions Based on the results of the study, shared counseling can be effective in the reduction of decisional conflict and regret, as well as rate enhancement of VBAC. Therefore, it can be concluded that this counseling method can be used in prenatal care to reduce the rate of repeated cesarean section. Trial registration IRCT20190506043499N1; Name of the registry: Iranian Registry of Clinical Trials; Registered 10. August 2019. URL of registry: https://en.irct.ir/trial/39538. Date of enrolment of the first participant to the trial: August 2019.

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Ultrasonographic assessment of strength of previous cesarean scar during pregnancy

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20181335 ◽

2018 ◽

Vol 7 (4) ◽

pp. 1458

Author(s):

Neeti Nisha S. Jha ◽

Sunita Maheshwari ◽

Shivani Barala

Keyword(s):

Cesarean Section ◽

Mode Of Delivery ◽

Control Group ◽

Previous Cesarean Section ◽

Cesarean Scar ◽

Scar Assessment ◽

Controversial Topic ◽

Sensitivity Specificity ◽

A Prospective Study ◽

Previous Cesarean

Background: Management of a woman who has undergone a previous cesarean section, has always been a controversial topic, with the inability to precisely confirm the integrity of the scarred lower uterine segment (LUS) being the indication of repeat cesarean section. The objective of this study is to evaluate the accuracy of ultrasonography (USG) in determining the LUS thickness in women with previous cesarean section (CS) and to assess its usefulness in predicting the risk of uterine rupture during a trial of vaginal birth.Methods: A prospective study was conducted on 100 women between 37 to 40 weeks of gestation with a previous CS and 100 primigravidae women serving as control. Thickness of LUS was measured by transabdominal USG. The decision for mode of delivery was based purely on obstetric ground. Patients undergoing CS were considered for analysis.Results: Mean LUS thickness was higher in the control group. Seventy-one patients of control group underwent repeat CS, in which 47 (66.1%) had normal intraoperative finding. 24 (33.7%) had abnormal LUS intraoperatively (LUS thinning). Of these, 20 (28.6%) showed abnormal LUS on USG (<5mm), but 4(5.6%) had normal ultrasonographic finding. Sensitivity, specificity, positive and negative predictive value of ultrasonographic evaluation were found to be 100%, 83.3%, 92% and 100% respectively.Conclusions: Prenatal scar assessment by USG is useful in evaluation of previous cesarean scar and in most cases a near accurate evaluation was possible.

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