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Indian Journal of Obstetrics and Gynecology Research


A study of outcome of pregnancy in patients with previous cesarean section in a tertiary set up


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Author Details: Shachi Joshi, Mittal Parmar

Volume : 4

Issue : 3

Online ISSN : 2394-2754

Print ISSN : 2394-2746

Article First Page : 288

Article End Page : 291


Abstract

Rates of primary caesarean sections has increased dramatically since the 1980’s. Consequently, an increasing proportion of pregnant women attending for care have had a previous caesarean and face the question of mode of delivery. These women are at increased risk of complication compared with other women. The primary choice for women in this situation is whether to have a repeat caesarean section or to attempt vaginal birth. Both repeat CS (ERCS) and VBAC have inherent risks for the mother and the baby.
Antenatal counselling and informed consent is crucial. Counselling should incorporate an individualized assessment of the risks and benefits of ERCS and planned VBAC modes of delivery. Women considering their options for birth after a single previous cesarean should be informed that, overall, the chances of successful planned VBAC are 72-76%.
VBAC should not be undertaken without thorough discussion of the risks during labour with the pregnant women. It should not be undertaken in units where full obstetric facilities such as emergency transfer to theatre, blood transfusion and continuous fetal monitoring are not available. Planned VBAC is associated with slightly increased perinatal risk than planned ERCS, although absolute risks are low for both modes of delivery. Planned VBAC exposes the woman to a very low (0.25%) additional risk for experiencing perinatal mortality or serious neonatal morbidity and an additional 1.5% risk of any significant morbidity compared with opting for ERCS from 39 weeks of gestation. Absolute risk of delivery-related perinatal death associated with VBAC is extremely low (4 per 10 000 (0.04%)) and comparable to the risk for nulliparous women in labour. Planned VBAC is therefore appropriate and may be offered to the vast majority of multiparous women with a singleton pregnancy of cephalic presentation at term with a single previous single lower segment caesarean delivery. From a maternal point of view, the safest outcome is spontaneous labour and spontaneous vaginal delivery while the outcome associated with the greatest morbidity is a failed VBAC resulting in caesarean section. In women with single previous lower segment caesarean section, who opted for ERCS, the major obstetric drawback is the risk of rare, but severe, adverse outcomes in future pregnancies.
The two major clinical factors determining the choice for VBAC are, therefore, the likelihood of a successful attempt and the mother’s plan for future pregnancies.


Keywords: TOLAC Trial of Labour after Caesarean Section, VBAC Vaginal Birth after Caesarean Section, ERCS Elective Repeat Caesarean Section, LSCS Lower Segment Caesarean Section