Vaginal Birth After Trial of Uterine Scar

Farrukh Naheed, Nikhat Ahsan, Aisha Qayyum, Farah Liaquat, Saadia Akram, Farheen Sheikh

Abstract

Objective

To determine the frequency of vaginal birth after trial of uterine scar and its associated maternal and perinatal complications.

Study design

Cross-sectional study.

Place & Duration of study

Department of Obstetrics and Gynaecology, Baqai Medical University Karachi, from January 2016 to December 2018.

Methodology

All admitted patients, booked or unbooked, with previous one cesarean section after 28 weeks were included in this study for the trial of labour after cesarean section (TOLAC). Demographic features like age, parity, gestational age, previous history of vaginal birth after cesarean section (VBAC) and previous history of assisted vaginal deliveries were recorded. Patients with previous one cesarean section, associated medical disorders and obstetric complications in previous pregnancies were excluded. Patients with BMI > 30 kg/m2 and expected fetal weight (EFW) =3.5 kg were also excluded. Data was analyzed through SPSS version 22.

Results

In 135 (64.9%) women successful VBAC occurred while 73 ( 35.1%)  had emergency cesarean section after TOLAC. 165 (79.3%) women belonged to age group <35 years. Multigravidas had lower success rate for TOLAC (n= 98 - 47.1%) as compared to (n=120 - 57%) women with low parity. Majority of women (n= 192 - 92.30%) were at term selected for TOLAC with the duration of >2 years since last delivery. There were 6 (3.4%) perinatal mortalities in  this study. Only 2 (1.4%) patients had postpartum haemorrhage due to scar dehiscence and placenta accreta which was an incidental diagnosis.

Conclusions

Despite the known complications of pregnancies with previous scar to be delivered vaginally TOLAC was appropriate for many pregnant women at term, leading to a successful outcome in high proportion of cases.

Key words

Trial of labour after cesarean section, Perinatal and maternal mortality, Elective repeat cesarean delivery, Vaginal birth after cesarean section.