Saheli Chandra1, Anjan Dasgupta2, Pradip Kumar Saha3, Kamal Kumar Dash4, Abirbhab Pal5, Partha Ghosh6
BACKGROUND
Pregnancy with one prior Caesarean section (CS) constitutes a high-risk group with
associated medical and legal implications. The dictum ‘once a Caesarean always a
Caesarean’ has now judiciously been replaced with ‘once a Caesarean, trial of
labour after selection’ because low transverse uterine incision has much lesser
chance of scar rupture. Though vaginal birth after Caesarean (VBAC) or trial of
scar (TOS) brings a significant change in modern obstetric practice in terms of
lower maternal and perinatal morbidities, apprehension of accidental scar rupture
during trial of labour with its undesirable consequences still prevents a good
number of obstetricians adopting this process. The purpose of the study was to
determine the outcome of pregnancy in relation to mode of delivery, i.e., either
elective repeat Caesarean section (ERCS) or vaginal birth after Caesarean (VBAC)
with maternal and perinatal complications in each mode.
METHODS
A hospital based prospective, longitudinal, and observational study of 300
pregnant women with previous one Caesarean delivery attended labour
emergency or out-patient department (OPD) at Midnapore Medical College of West
Bengal, was carried out, approved by the institutional ethical committee.
Gestational age < 37 weeks and > 42 weeks and h\o previous uterine surgery like
myomectomy, hysterotomy, classical CS were excluded from the study. Data
collected was analysed using statistical package for the social sciences (SPSS)
software version 20. Descriptive statistics were used to analyse the continuous
and categorical data and expressed in the form of mean and percentage whereas
proportions were analysed using chi-square test. A P - value ≤ 0.05 was
considered statistically significant.
RESULTS
Out of 300 pregnancies, 140 subjects were given trial of labour (TOL). Of which
89 subjects (63.6 %) had successful VBAC and 51 subjects (36.4 %) had repeat
Caesarean sections. Among 211 subjects of repeat Caesarean section, 53 subjects
(25.12 %) had indicated for scar tenderness and 73 subjects (34.59 %) had
elective repeat Caesarean section (ERCS) due to protracted or arrested cervical
dilatation. Those having previous vaginal delivery (VD), had more incidences of
VBAC in present pregnancy than those who had no previous VD (P ≤ 0.005);
Maternal morbidity (33.65 % ERCS versus 10.11 % VD group, P ≤ 0.05) and
neonatal morbidity (12.3 % ERCS versus 2.46% VD group, P ≤ 0.05) was
significantly higher in ERCS group.
CONCLUSIONS
Trial of labour (TOL) should be given in well-equipped hospital. In carefully
selected cases, it is a safe procedure and often rewarding, thus incidence of repeat
CS can be reduced. Those who had a history of vaginal delivery, VBAC often
successful.
