SUCCESSFUL TRIAL OF LABOR AFTER PRIMARY AND REPEATED CESAREAN SECTIONS: A CASE REPORT

Objective The moment of admission for delivery may be inappropriate for offering an intrauterine device (IUD) to women without prenatal contraception counseling. However, in countries with high cesarean rates and deficient prenatal contraception counseling, this strategy may reduce unexpected pregnancies and repeated cesarean sections. Methods This was a prospective cohort study involving 100 women without prenatal contraception counseling. Postplacental IUD was offered after admission for delivery and placed during cesarean. The rates of IUD continuation, uterine perforation, and endometritis were assessed at 6 weeks and 6 months, and the proportion of women continuing with IUD at 6 months was assessed with respect to the number of previous cesareans. Results Ninety-seven women completed the follow-up. The rate of IUD continuation was 91% at 6 weeks and 83.5% at 6 months. The expulsion/removal rate in the first 6 weeks was not different from that between 6 weeks and 6 months (9 vs 9.1%, respectively). There were 2 cases of endometritis (2.1%), and no case of uterine perforation. Among 81 women continuing with intrauterine device after 6-months, 31% had undergone only the cesarean section in which the IUD was inserted, 44% had undergone 2 and 25% had undergone 3 or more cesarean sections. Conclusion Two thirds of the women who continued with IUD at 6 months had undergone 2 or more cesarean sections. Since offering trial of labor is unusual after 2 or more previous cesareans, we believe that offering IUD after admission for delivery may reduce the risk of repeated cesarean sections and its inherent risks.

Download Full-text

Assessment of maternal and fetal outcome in trial of labor after cesarean

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20191219 ◽

2019 ◽

Vol 8 (4) ◽

pp. 1563

Author(s):

Sunita Kumari Beer ◽

Jaya Chaudhary ◽

Kalpana Tiwari ◽

Sonam Choudhary

Keyword(s):

Prospective Observational Study ◽

Fetal Outcome ◽

Clinical Settings ◽

Cesarean Sections ◽

Singleton Pregnancy ◽

Trial Of Labor ◽

Predictor Of Success ◽

Uterine Scar ◽

Alternative Choice

Background: Nowadays, cesarean sections are increasing consistently. Repeat cesarean sections are performed for a large percentage and associated with a higher rate of surgical complications and Long-term morbidities. The trial of labor after cesarean offers an alternative choice. This study carried out to assess the maternal and fetal outcome and to evaluate various parameters as a predictor of success of TOLAC.Methods: This prospective observational study conducted on 150 pregnant women with one previous LSCS who delivered at Mahatma Gandhi hospital, from January 2017 to July 2018. Patient having a singleton pregnancy, cephalic presentation, adequate pelvis size with spontaneous onset of labor were included. Cases were monitored carefully during the labor. Emergency LSCS was done if any indication appeared.Results: 78% of cases delivered safely by the vaginal birth and 22% of cases had an emergency repeat cesarean section (EmRCS). Favorable Bishop Score, active stage of labor and prior vaginal delivery were associated with higher success rate. One (0.66%) case of uterine scar rupture and 2 (1.33%) cases of scar dehiscence noted. No maternal mortality observed. Perinatal mortality occurred in 2 cases (1.33%).Conclusions: Present study shows that appropriate clinical settings and the properly selected group of patients can make the TOLAC safe and effective.

Download Full-text

787: Prediction of successful trial of labor after cesarean delivery: a validation study in the upper Midwest

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2012.10.125 ◽

2013 ◽

Vol 208 (1) ◽

pp. S330-S331

Author(s):

Angelica Garrett ◽

Sherif El Nashar ◽

Todd Stanhope ◽

Adrianne Racek ◽

Myra Wick ◽

...

Keyword(s):

Cesarean Delivery ◽

Validation Study ◽

Upper Midwest ◽

Trial Of Labor ◽

Successful Trial

Download Full-text

Trial of Labor After Two Cesarean Sections Versus Repeat Cesarean Section

Obstetrics and Gynecology ◽

10.1097/01.aog.0000663816.09938.41 ◽

2020 ◽

Vol 135 ◽

pp. 177S

Author(s):

Rebecca Horgan ◽

Saif Hossain ◽

Adriana Fulginiti ◽

Robert Massaro ◽

Robert Graebe

Keyword(s):

Cesarean Section ◽

Cesarean Sections ◽

Trial Of Labor ◽

Repeat Cesarean Section

Download Full-text

VBAC in twin gestations: Higher birth weight in twin a is associated with successful trial of labor

American Journal of Obstetrics and Gynecology ◽

10.1016/s0002-9378(97)80532-7 ◽

1997 ◽

Vol 176 (1) ◽

pp. S136

Author(s):

J. Fisch ◽

M. Newman ◽

T. Feng ◽

J. Huddleston

Keyword(s):

Birth Weight ◽

Trial Of Labor ◽

Successful Trial

Download Full-text

Pregnancy in Non-Communicating Unicornuate Uterus: Diagnosis Difficulty and Outcomes – a Case Report

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0037-1607046 ◽

2017 ◽

Vol 39 (11) ◽

pp. 640-644 ◽

Cited By ~ 3

Author(s):

Camila Souza ◽

Gabriela Dorneles ◽

Giana Mendonça ◽

Caroline Santos ◽

Francisco Gallarreta ◽

...

Keyword(s):

Case Report ◽

Uterine Rupture ◽

Intrauterine Growth Restriction ◽

Delayed Diagnosis ◽

Pregnancy Induced Hypertension ◽

Cesarean Sections ◽

Rudimentary Horn ◽

Intrauterine Growth ◽

Unicornuate Uterus ◽

Induced Hypertension

AbstractApproximately 1 in every 76,000 pregnancies develops within a unicornuate uterus with a rudimentary horn. Müllerian uterus anomalies are often asymptomatic, thus, the diagnosis is a challenge, and it is usually made during the gestation or due to its complications, such as uterine rupture, pregnancy-induced hypertension, antepartum, postpartum bleeding and intrauterine growth restriction (IUGR). In order to avoid unnecessary cesarean sections and the risks they involve, the physicians should consider the several approaches and for how long it is feasible to perform labor induction in suspected cases of pregnancy in a unicornuate uterus with a rudimentary horn, despite the rarity of the anomaly. This report describes a case of a unicornuate uterus in which a pregnancy developed in the non-communicating rudimentary horn and the consequences of the delayed diagnosis.

Download Full-text

Trial of Labor and Vaginal Birth after Three Previous Cesarean Sections: Report of Two Special Cases

Zeitschrift für Geburtshilfe und Neonatologie ◽

10.1055/a-1642-1113 ◽

2022 ◽

Author(s):

Arrigo Fruscalzo ◽

Marwa Elgendi ◽

Marcus Gantert

Keyword(s):

Vaginal Birth ◽

Cesarean Sections ◽

Natural Childbirth ◽

Case Presentation ◽

Trial Of Labor ◽

Detailed Explanation ◽

Special Cases ◽

Potential Risks ◽

First Time ◽

Previous Cesarean

Abstract Background Natural childbirth could represent a deeply rooted need for many women, even in exceptional situations such as after 3 previous caesarean sections. Case presentation The first patient, a 28-year-old 6th gravida and 3rd para, first presented in the 40+3 week of pregnancy desiring a vaginal birth, after all the other hospitals in the area had refused her request. A detailed explanation of potential risks was given and, when 2 days later contractions started, she gave birth to a newborn of 4450 g spontaneously, without complications. A month later, a second woman, 42 years old, 5th gravida, 3rd para, read about the above-mentioned case on social media and decided to attempt a natural delivery after 3 caesarean sections at our hospital as well. She presented herself for the first time in the 41+1 week of pregnancy in our delivery room with an onset of labor after rupture of the membranes and gave birth on the same day, spontaneously without complications, to a 4150 g heavy healthy newborn. Conclusions The wish to attempt a spontaneous birth after 3 previous caesarean sections can be deeply anchored and should be professionally approached by obstetricians, even if counseling and management can be challenging.

Download Full-text

Successful Trial of Octreotide and Ketorolac for the Management of Increased Biliary Drain Output: A Case Report

Cureus ◽

10.7759/cureus.1421 ◽

2017 ◽

Author(s):

Fasil Tiruneh ◽

Ahmad Awan ◽

Abdullahi Musa ◽

Daniel Chen

Keyword(s):

Case Report ◽

Successful Trial

Download Full-text