Delivery after a previous caesarean section at the Chris Hani Baragwanath Hospital

DSpace/Manakin Repository

Show simple item record

dc.contributor.author Sayed, Muhammad Shafique
dc.date.accessioned 2008-06-06T11:46:31Z
dc.date.available 2008-06-06T11:46:31Z
dc.date.issued 2008-06-06T11:46:31Z
dc.identifier.uri http://hdl.handle.net/10539/4939
dc.description.abstract Abstract Introduction Chris Hani Baragwanath (CHB) hospital has 20 000 deliveries per annum, with 25% by caesarean section (CS). Therefore, vaginal birth after caesarean section (VBAC) is an important delivery option. We questioned the reasons for the low VBAC success following trial of labour (TOL). The primary objective was to determine the proportion of eligible patients attempting TOL and the VBAC success rate. Secondary objectives were to establish reasons for failed VBAC, predictive factors for VBAC, and maternal and neonatal morbidity and mortality. Methodology A retrospective descriptive study by record review, analysing demographic, obstetric and delivery outcome variables of women with one prior CS in a subsequent pregnancy. Results From the 340 patients eligible for VBAC, 287 (84.4%) attempted TOL and 53 (15.6%) had an elective repeat caesarean section (ERCS). VBAC success was 51.6% (148/287). Prelabour rupture of membranes and prolonged latent phase of labour resulted in 40% of failed VBAC. Successful VBAC was associated with a higher parity, lower birth weight and lower gestation (p<0.001). Positive predictors of successful VBAC were previous vaginal birth (p=0.004), previous VBAC (p=0.038), previous CS for malpresentation (p=0.012), birth weight <3500g (p=0.003), and gestation ≤ 39 weeks (p<0.001). Negative predictors were previous CS for cephalopelvic disproportion (p=0.003) and women with no prior vaginal deliveries (p<0.001). There was no maternal mortality. Complications however, included 2 uterine ruptures, 2 uterine dehiscences, 4 hysterectomies, and one intrapartum fetal death. Adverse maternal outcomes were increased with TOL compared to ERCS (p=0.038), and more so with failed compared to successful VBAC (p=0.002). Adverse neonatal outcomes were also increased with TOL compared to ERCS (p=0.048), however there was no difference in neonatal outcomes between failed and successful VBAC (p=0.420). Conclusion VBAC remains a viable option for patients with one prior CS in this setting, despite a lower VBAC success than developed countries. Failed VBAC due to prelabour rupture of membranes and prolonged latent phase of labour remains a problem. en
dc.format.extent 1321326 bytes
dc.format.mimetype application/pdf
dc.language.iso en en
dc.subject VBAC en
dc.subject vaginal birth after caesarean section en
dc.title Delivery after a previous caesarean section at the Chris Hani Baragwanath Hospital en
dc.type Thesis en


Files in this item

This item appears in the following Collection(s)

Show simple item record

Search WIReDSpace


Browse

My Account

Statistics