Optimization of clinical outcome of women with previous one lower segment cesarean section

Mamdoh Eskandar, Jameelah Aboud, Majed Alshahrani, Mervat Hassanein, Azza Alyamani

Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha, KSA.
Department of Obstetrics and Gynecology and Reproductive Medicine, College of Medicine, King Khalid University, Abha, KSA.
Department of Obstetrics and Gynecology, Abha General Hospital, Abha, KSA.

DOI: 10.4236/ojog.2012.23055                

Abstract

Background and Objectives: To investigate the outcome in women with planned (VBAC) in comparison to Repeat Cesarean Section (RCS) and to those undergoing vaginal birth. Design and settings: Retrospective study, women with a history of one lower segment cesarean section (LSCS) admitted to Abha General Hospital for delivery from September, 2010 to February, 2011. Subjects and Methods: The demographic maternal and neonatal data and data concerning the course of delivery were reviewed in 418 women underwent trial of labor (TOL) and subjected to statistical analysis to study the predictive factors and outcome. All cases were divided into 3 groups, VBAC group (212 women), RCS group (206 women) and the neonates of the VBAC group were compared to those of a control group consists of 287 neonates who delivered vaginally. Results: The success rate of VBAC was 50.72%, with no uterine rupture or wound dehiscence. Failure to progress was the most common (40.2%) indication of RCS followed by fetal distress (29.9%). Young maternal age (P < 0.05), previous vaginal deliveries after CS (P < 0.05) and occiputo anterior position (P < 0.01) were significantly associated with successful VBAC. Neonatal Intensive Care Unit (NICU) admission was significantly higher in the RCS group (P < 0.001), while no significant difference was found between NICU admission in the VBAC and the control groups. Conclusion: VBAC should remain an available option. Informed consent, good reporting and thorough documentation of the VBAC decision are crucial. During TOL, continuous fetal monitoring and, ultrasound evaluation of the previous scar are recommended. Emergency CS should be considered if duration of the TOL is prolonged with non reassuring CTG.

Keywords

VBAC; TOL; RCS; Pregnancy Outcome

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Hobel, C.J., Lu, M.C. and Gambone, J.C. (2010) A life-course perspective for women’s health care. Safe, ethical and effective practice. In: Gambone, J.C. and Hobel, C.J., Eds., Essentials of obstetrics and gynecology, 5th Edition, Elsevier, Philadelphia, 3-11.
[2]	Rozen, G., Ugoni, A.M. and Sheehan, P.M. (2010) A new perspective on VBAC: A retrospective cohort study. WWW.PubMed.com
[3]	American College of Obstetricians and Gynecologists (2010). VBAC guidelines published in August. http://www.acog.org/
[4]	Mankuta, D.D., Leshno, M.M., Menasche, M.M. and Brezis, M.M. (2003) Vaginal birth after CS: Trial of labor or repeat CS. A decision analysis. American Journal of Obstetrics & Gynecology, 189, 714-719. doi:10.1067/S0002-9378(03)00833-0
[5]	Finley, B.E. and Gibbs, C.E. (1986) Emergent cesarean delivery in patients undergoing a trial of labor with a transverse lower segment scar. American Journal of Obstetrics & Gynecology, 155, 936-939.
[6]	American College of Obstetricians and Gynecologists (2004) Practice bulletin 54: VBAC. Washington DC.
[7]	Shipp, T.D., Zelop, C.M., Repke, J.T., Cohen, A., Lieberman, E. (2001) Interdelivery interval and risk of symptomatic uterine rupture. Obstetrics & Gynecology, 97, 175-177. doi:10.1016/S0029-7844(00)01129-7
[8]	Lydon-Rochelle, M., Holt, V.L., Easterling, T.R. and Martin, D.P. (2001) Risk of uterine rupture during labor among women with a prior cesarean delivery. The New England Journal of Medicine, 345, 3-8. doi:10.1056/NEJM200107053450101
[9]	Elkousy, M.A., Sammel, M., Stevens, E., Peipert, J.F. and Macones, G. (2003) The effect of birth weight on vaginal birth after cesarean delivery success rates. American Journal of Obstetrics & Gynecology, 188, 824-830. doi:10.1067/mob.[phone]
[10]	Zelop, C.M., Shipp, T.D., Cohen, A., Repke, J.T. and Lieberman, E. (2001) Trial of labor after 40 weeks gestation in women with prior cesarean. Obstetrics & Gynecology, 97, 391-393. doi:10.1016/S0029-7844(00)01175-3
[11]	Chattopadhyay, S.K., et al. (1994) Planned vaginal delivery after two previous cesarean sections. British Journal of Obstetrics and Gynaecology, 101, 498-500.
[12]	Dekker, G.A., Chan, A., Luke, C.G., Priest, K., Riley, M., Halliday, J., King, J.F., Gee, V., O’Neill, M., Snell, M., Cull, V. and Cornes, S. (2010) Risk of uterine rupture in Australian women attempting vaginal birth after one prior caesarean section: A retrospective population-based cohort study. An International Journal of Obstetrics & Gynaecology, 117, 1358-1365. doi:10.1111/j.1471-0528.2010.02688.x
[13]	Flamm, B.L. (1997) Once a cesarean always a controversy. Obstetrics & Gynecology, 90, 312-315. doi:10.1016/S0029-7844(97)00263-9
[14]	McNally, O.M. and Tumer, M.J. (1999) Induction of labor after one previous cesarean section. Australian and New Zealand Journal of Obstetrics and Gynaecology, 39, 425-429. doi:10.1111/j.1479-828X.1999.tb03126.x
[15]	Rosen, M.G., Dickinson, J.C. and Westhoff, C.L. (1991) Vaginal birth after cesarean: A meta-analysis of mortality and mortality. Obstetrics & Gynecology, 77, 465-470.
[16]	O’Brien, J.M., Barton, J.R. and Donaldson, E.S. (1996) The management of placenta percreta conservative and operative strategies. American Journal of Obstetrics & Gynecology, 175, 1632-1638.
[17]	Smith, G.C., Pell, J.P., Cameron, A.D. and Dobbie, R. (2002) Risk of perinatal death associated with labor after previous cesarean delivery in uncomplicated term pregnancies. The Journal of the American Medical Association, 287, 2684-2690. doi:10.1001/jama.287.20.2684
[18]	Mark, B., Landon, M.D., John, C., Hauth, M.D., Kenneth, J., et al. (2004) Maternal and perinatal outcomes associated with a trial of labor after cesarean delivery. The New England Journal of Medicine, 351, 2581-2589. doi:10.1056/NEJMoa040405