Publication:

Maternal and foetal outcome in term patients with previous one lower segment cesarean section

Background In modern day obstetric practice we encounter increasing number of patients with history of caesarean section because of rise in primary caesarean due to changing trends in their indications. There is increasing fear and anxiety by obstetricians for managing these cases from medico legal point of view. Present study was done to look at the feto-maternal outcome and for   appropriate mode of delivery and overall  to conduct the proper management of patients with previous one  lower segment caesarean section so as to achieve the goal of healthy mother and baby at the end of pregnancy.

Methods This is a Retrospective observational study carried out at G S Medical College and KEM Hospital, Parel Mumbai 12 Maharashtra India from January 2015 to December 2015. All patients enrolled in study were with H/O previous lower segment caesarean section. Classical CS, inverted T incision other medical complications were excluded. Patients were evaluated thoroughly by history and examination and mode of delivery was decided. Informed consent was taken of the patients who were fit for VBAC ie Vaginal Birth after caesarean section. Antenatal, intrapartum and post-partum records were evaluated. Women who were given trial of VBAC, progressed into labour spontaneously. Labour was constantly supervised by competent staff and meticulously monitored by CTG.

Results All the patients were counselled throughout their ANC period for VBAC Out of 7680 confinements 588 patients with previous one LSCS were encountered and among these patients 311 consented for vaginal birth and 277 underwent elective LSCS. From the 311 patients who consented for VBAC 165 delivered successfully 146 required Emergency LSCS. In VBAC group, 8 patients required foceps and in 2 patients required vaccum .There were 42 patients who underwent emergency LSCS for scar tenderness from which 10 patients had scar dehiscence and one patient had rupture uterus.

Conclusions Successful vaginal delivery in patients with history of previous caesarean is associated with better outcomes than emergency caesarean section and hence proper counseling in ANC period and selection of patients for trial of VBAC is necessary, especially in underdeveloped nations where limited resources and facilities of feto-maternal monitoring are available.