Delivery after a previous caesarean section at the Chris Hani Baragwanath Hospital
Date
2008-06-06T11:46:31Z
Authors
Sayed, Muhammad Shafique
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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.
Description
Keywords
VBAC, vaginal birth after caesarean section