Abstract

Background: The rate of primary caesarean section (CS) is on the rising trend. Vaginal birth after CS (VBAC) can be an alternative to reduce this rate of CS worldwide. Antenatal examination and intrapartum monitoring are the most important factors for VBAC.

Aims: The aim of this study is to determine the prevalence of VBAC at SBH in selected cases. To analyze the maternal and fetal outcome of VBAC and repeat CS cases.

Methodology: It is a cross-sectional institute-based study carried out in Shree Birendra hospital, a tertiary level Nepalese Army Hospital, from March 2019 to March 2020. The study population included cases with one previous caesarean section fulfilling the inclusion criteria of Royal College of Obstetrician and Gynaecology (RCOG) for VBAC. After counseling for VBAC, the data were estimated of those who were willing for VBAC and those who refused. Trial of labor was given to the patients accepted for VBAC. Feto-maternal outcome were analyzed of VBAC and of repeat CS.

Results: There were total of 108 cases of previous LSCS reported at ANC OPD, among them 23 cases were excluded from the study as they were not meeting the RCOG inclusion criteria, 85 cases were enrolled in the study. Out of 85 cases, 75 (88.23%) refused to undergo VBAC, only 10 cases (11.76%) accepted to undergo trial of labor. Out of 10 cases, 5 (50%) had successful VBAC. The sample size was too small to come to any conclusion, still it is observed that women who had an emergency cesarean section in their first delivery had lower VBAC success particularly those with failed induction. No maternal and neonatal mortality observed.

Conclusion: Vaginal Birth after Caesarean section is relatively safe, provided it is conducted in carefully selected cases and under constant supervision. Spontaneous onset of labor, good Bishop score and average sized baby were good predictors of successful VBAC.

Keywords: VBAC; Antenatal; Intrapartum; Bishop Score; SBH; ANC

References

1. Pokharel S., et al. “Trial of Vaginal Birth After Caesarean (VBAC): Sharing Experience From a Tertiary Care Center of Eastern Nepal”. Journal of Nobel Medical College12 (2018): 18-25
2. Bangal B., et al. “Vaginal Birth after Cesarean Section”. North American Journal of Medical Sciences 2 (2013): 140-144
3. Ying H., et al. “Vaginal Birth after Cesarean Section in Taiwan: a Population-Based Study”. Journal of Clinical Medicine 8 (2019): 1203.
4. Li Xiu-Yun., et al. “Predicting the success of vaginal birth after cesarean delivery: a retrospective cohort study in China”. BMJ 5 (2018-9): 027807.
5. Balachandran L., et al. “Pregnancy Outcome in Women with Previous One Cesarean Section”. Journal of Clinical and Diagnostic Research2 (2014): 99.
6. Pooja P. “Changing trends in caesarean deliveries at a tertiary care centre: a ten-year appraisal”. Journal of Society of Surgeons of Nepal 2 (2014): 164.
7. Bangal BV., et al. “Vaginal birth after caesarean section: why and how?”. International Journal of Reproduction, Contraception, Obstetrics and Gynecology 12 (2017): 5554-5558.
8. Qazi Q., et al. “Maternal and Fetal Outcome in Successful Vaginal Birth after Caesarean Section versus Repeat Caesarean Section”. JPMI 27 (2013): 414-418.
9. Devkare V., et al. “Maternal and fetal Outcome of VBAC after First Previous LSCS in A Tertiary Care Teaching Hospital of Western India”. International Journal of Current Research in Medical Sciences7 (2017): 002.
10. Birara M and Gebrehiwot Y. “Factors associated with success of vaginal birth after one caesarean section (VBAC) at three teaching hospitals in Addis Ababa, Ethiopia: a case control study”. BMC Pregnancy and Childbirth (2013): 13-31.
11. Knight HE., et al. “Vaginal birth after caesarean section: a cohort study investigating factors associated with its uptake and success”. British Journal of Obstetrics and Gynaecology 121 (2014): 183-193.
12. Jain R. “Safety of vaginal birth after single previous lower segment caesarean: a retrospective analysis of 200 cases”. International Journal of Reproduction, Contraception, Obstetrics and Gynecology 7 (2018): 2393.
13. gov. mmwrhtml. Vaginal Birth After Cesarean Birth--- California 1996-2000.
14. Lundgren I., et al. “Clinicians’ views of factors of importance for improving the rate of VBAC: a study from countries with low VBAC”. BMC Pregnancy and Childbirth (2016).
15. Senturk MB., et al. “Factors associated with successful vaginal birth after caesarean section and outcomes in rural area of Antolia”. International Journal of Women's Health 7 (2015): 693-697.
16. Young B C., et al. “Mode of delivery after a previous cesarean birth, and associated maternal and neonatal morbidity”. CMAJ 18 (2018): E556-E564.
17. Cragin EB. “Conservatism in Obstetric, New York”. Journal of Medicine 104 (1916): 1-3.
18. Royal College of Obstetricians and Gynaecologists. Birth after previous cesarean birth, Green -top Guideline No 45, London RCOG (2015).
19. American College of Obstetricians and Gynaecologists (ACOG). Vaginal birth after previous cesarean delivery (Washington DC, ACOG, 2010) and Royal College of Obstetricians and gynaecologists (RCOG), Birth after previous cesarean section Green-top guidelines No 45, London RCOG (2007).
20. Canada Society of Obstetricians and Gynaecologists of Canada, Vaginal birth after previous cesarean birth, clinical practice guideline No 68, Ottawa (ON) SOCG (1997).
21. Rozen G., et al. “A new perspective on VBAC: A retrospective cohort study”. Women Birth1 (2011): 3-9.
22. Cunningham F., et al. Williams Obstetrics. 24th ed. New York: McGraw-Hills (2010).
23. Yousaf F., et al. “Mode of delivery after c/section”. Ann king Edward Med Uni, 8 (2002): 66-67.
24. Elkhousy M., et al. “The effect of birth weight on vaginal birth after caesarean delivery success rate”. American Journal of Obstetrics and Gynecology 188 (2003): 824-830.
25. MacDorman M., et al. “Recent trends and patterns in cesarean and vaginal birth after cesarean section (VBAC) deliveries in the United States”. Clinical Perinatology 38 (2011): 179-192.
26. Cox KJ. “Provider’ perspectives on the vaginal birth after cesarean guidelines in Florida, United States: a qualitative study”. BMC Pregnancy Child Birth 11 (2011): 72.
27. Spong CY. “To VBAC or not to VBAC”. PLoS Medicine 9 (2012): e1001191
28. National Guideline Clearinghouse. Vaginal birth after cesarean delivery. Rokville, MD: NGC (2011).
29. Hinkins G., et al. “Caesarean section on request at 39 weeks: impact on shoulder dystocia, fetal trauma, neonatal encephalopathy and intrauterine fetal demise”. Seminar on Perinatology 30 (2006): 276-287.
30. Jha M. “Pregnancy outcome of single previous cesarean section”. Journal of the Nepal Health Research Council 7 (2009): 25-28.
31. Patel R and Jain L. “Delivery after caesarean: short term perinatal outcomes”. Seminar on Perinatology 34 (2010): 272-280.
32. Bais JM., et al. “Vaginal Birth after caesarean section in a population with a low overall caesarean section rate”. European Journal of Obstetrics and Gynecology and Reproductive Biology 96 (2001): 158-162.
33. American College of Obstetricians and Gynaecology (ACOG). “ACOG Practice Bulletin: vaginal birth after previous cesarean delivery: Clinical management guidelines”. International Journal of Gynecology and Obstetrics 54 (2004): 197-204.
34. Ghafarzadeh M., et al. “Vaginal Birth after cesarean section: a retrospective study”. Pakistan Journal of Medical Sciences 26:4 (2010) 987-989.
35. Horowitz BJ., et al. “Once a cesarean always a cesarean”. Obstetrical and Gynecological Survey 36 (1981): 592-597.

Citation

Citation: Ratna A Khatri., et al. “Vaginal Birth After Caesarean Section - Experience in Shree Birendra Hospital".Acta Scientific Nutritional Health 4.11 (2020): 57-65.

Copyright

Copyright: © 2020 Ratna A Khatri., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.