DOI: https://dx.doi.org/10.18203/2320-1770.ijrcog20163438
Published: 2016-12-15

Outcome in women with previous caesarean section in a secondary care hospital in rural South India

Anuradha Dhanasekaran, Anne George Cherian, Aabidha Parveen, Paul Emmanuel

Abstract


Background: Caesarean section has become increasingly the common method of delivery. From 1980 to 2001 the rate in UK has increased from 9% to 21% of all births. The aim of the study was to find out the outcome of delivery in women with previous cesarean section, the mode of delivery, maternal and fetal outcome of labour and various factors which influence the mode of delivery.

Methods: 150 women with one previous caesarean section who attended the antenatal clinic and fit the inclusion criteria were enrolled in the study.

Results: Success rate of VBAC was 30.5% among those included in trial of labour after caesarean section (TOLAC). 60.7% of the enrolled women underwent elective repeat caesarean section of which 54.9% were at the patients’ request. Favorable Bishop’s score (p= 0.0002) and previous cesarean section for breech (p=0.191) are positively associated with VBAC. Incidence of maternal complications in the study was 10.67% and 2.5% babies had an Apgar <7 at 5 minutes. There was no maternal or neonatal mortality.

Conclusions: The VBAC rate in the study is 30.5% in carefully selected patients for trial of scar with the existing litigation pressure. TOLAC can be judiciously implemented in carefully chosen patients even in rural health setting equipped with required facilities. Patient’s participation in the decision making has brought down the VBAC rate which is reflected by the increased repeat elective cesarean section done at patients’ request (54.9%). Factors such as prior vaginal delivery, favorability of the cervix, indication of previous cesarean section, onset of labour and birth weight are highly significant in deciding the success of VBAC and can be used to improve VBAC rates in practice.


Keywords


Previous caesarean section, TOLAC, Secondary hospital, Outcomes

Full Text:

PDF

References


624 RCOG NSCS Audit - nscs_audit.pdf. Available from: https: //www.rcog.org.uk /globalasset s/documents/guidelines/research-audit/nscs_audit.pdf. Accessed on 12 January 2016.

Health and social care information centre 1 trevelyan square. 2012. Available at: http: //www.hscic.gov.uk /article/2021/Website-Search? productid= 116&q= CAESAREAN+SECTION+2014&sort=Relevance&size=10&page=1&area=both#top. Accessed on 3 January 2016.

Pahari K, Ghosh A. Study of pregnancy outcome over a period of five years in a postgraduate institute of west Bengal. J Indian Med Assoc. 1997;95(6):172-4.

Sreevidya S, Sathiyasekaran BWC. High caesarean rates in Madras (India): a population-based cross sectional study. BJOG Int J Obstet Gynaecol. 2003;110(2):106-11.

Villar J, Valladares E, Wojdyla D, Zavaleta N, Carroli G, Velazco A, et al. Caesarean delivery rates and pregnancy outcomes: the 2005 WHO global survey on maternal and perinatal health in Latin America. Lancet. 2006;367(9525):1819-29.

Kambo I, Bedi N, Dhillon BS, Saxena NC. A critical appraisal of cesarean section rates at teaching hospitals in India. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. 2002;79(2):151-8.

Smith A. New guidelines seek to cut rate of repeat cesarean sections. Available at http://blog.syracuse.com/cny/2010/07/new_guidelines_seek_to_cut_rate_of_repeat_cesarean_sections.html. Accessed on 20 January 2015.

Guise JM, Eden K, Emeis C, Denman MA, Marshall N, Fu RR, et al. Vaginal birth after cesarean: new insights. Evid Report Technology Assess. 2010;(191):1-397.

Sachs BP, Kobelin C, Castro MA, Frigoletto F. The risks of lowering the cesarean-delivery rate. N Engl J Med. 1999;340(1):54-7.

Martin JA, Hamilton BE, Ventura SJ, Menacker F, Park MM, Sutton PD. Births: final data for 2001. Natl Vital Stat Rep Cent Dis Control Prev Natl Cent Health Stat Natl Vital Stat Syst. 2002;51(2):1-102.

Flamm BL. Vaginal birth after caesarean (VBAC). Best Pract Res Clin Obstet Gynaecol. 2001;15(1):81-92.

Weinstein D, Benshushan A, Tanos V, Zilberstein R, Rojansky N. Predictive score for vaginal birth after cesarean section. Am J Obstet Gynecol. 1996;174(1):192-8.

Vaginal birth after one previous lower segment caesarean section. Available at: http:// www.jkscience.org/archive/volume134/Vaginal%20Birth%20After%20One%20Previous%20Lower%20Segment%20Caesarean%20Section.pdf. Accessed on 2 January 2016.

Mock CN, Visser L, Elkins TE, Wilson JB. Vaginal delivery after previous cesarean section in a rural West African hospital. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. 1991;36(3):187-93.

Bedoya C, Bartha JL, Rodriguez I, Fontan I, Bedoya JM, Ramos SJ. A trial of labor after cesarean section in patients with or without a prior vaginal delivery. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. 1992;39(4):285-9.

Madaan M, Agrawal S, Nigam A, Aggarwal R, Trivedi SS. Trial of labour after previous caesarean section: the predictive factors affecting outcome. J Obstet Gynaecol J Inst Obstet Gynaecol. 2011;31(3):224-8.

Hin LY, Khairuddin Y, Ng KB. The predictive value of extremes of birth weight, mother’s height and ethnic origin on the likelihood of emergency caesarean section. Asia-Ocean J Obstet Gynaecol. 1994;20(4):389-94.