S. Tahmina1, Satish Korah Kuruvila2, Mary Daniel3
BACKGROUND
The rising caesarean section rates can be curtailed by increasing the rates of Vaginal Birth After Caesarean (VBAC). Ability to predict vaginal birth after caesarean with certainty may enable better counselling and decision making regarding mode of delivery for pregnant women with a previously scarred uterus.
AIM
To assess the accuracy of a simple validated vaginal birth after caesarean score in predicting the mode of delivery in pregnant women with previous one caesarean section.
MATERIALS AND METHODS
Data for all patients who delivered at this institution between November 2011 and October 2013 were reviewed. Data of women who delivered after one caesarean section were analysed and details of the index pregnancy, labour and mode of delivery were noted. A vaginal birth after caesarean prediction model was applied to all women who underwent a Trial of Labour After Caesarean (TOLAC) using data at admission. Women who delivered after two or more caesarean sections were excluded from the study. The primary outcome assessed was the mode of delivery.
SETTINGS AND DESIGN
Retrospective Cohort study at a 650-bedded tertiary care hospital in South India.
STATISTICAL ANALYSIS
For categorical variables, data was compiled as frequency and percent. For continuous variables, data was calculated as mean±SD. Performance of the vaginal birth after caesarean score was assessed by receiver operating characteristic curve analysis.
RESULTS
Six hundred and eighty-seven women were delivered by caesarean section. Among them, 280 women who had a previous caesarean section were included in the study. Vaginal birth after caesarean scores were computed for 82 women who underwent a trial of labour after caesarean. 57.3% had a successful vaginal birth after caesarean and the remaining had a repeat caesarean section after a failed trial of labour. The score performed fairly well with an area under receiver operating characteristic curve of 0.75.
CONCLUSION
The vaginal birth after caesarean score maybe useful tool in counselling eligible women in favour of a trial of labour after caesarean thereby reducing the number of elective repeat caesarean sections.
