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Background: Globally, there is an increased trend of cesarean section (CS). Repeat CS is associated with various complications. Successful vaginal birth after caesarean section (VBAC) helps to decrease CS rate and its associated morbidities. Practice of protocol of applying FLAMM score and monitoring by partogram reduces the rate of cesarean section in the previous one lower segment cesarean section patient. Aims and Objectives: The present study is conducted to evaluate the impact of FLAMM scoring for vaginal birth after CS on obstetrics and perinatal outcome in case of the previous one lower segment CS delivery. Materials and Methods: The prospective and observational study was conducted in Obstetrics and Gynaecology department of one of the teaching institutes of Ahmedabad over a period of 1 year. Total 100 pregnant women from labour room with history of the previous one CS, who gave consent for trial of labor after the previous cesarean (TOLAC) were selected and FLAMM score applied on them. Study participants were divided in two groups according to outcome. Group A: Successful TOLAC and Group B: Failed TOLAC. Maternal and neonatal outcome was measured in both groups. Results: Out of 98 patients <40 years, 74.48% had VBAC and 25% had failed TOLAC and two patients were >40 years of age had VBAC. Out of 94 patients with favorable FLAMM’s score, 79% (n = 75) had VBAC and 100% (n = 6) with unfavorable FLAMM had CS. Conclusion: Careful patient selection for TOLAC is of utmost priority to increase success rate and decrease complications. FLAMM scoring system is a very efficient guiding tool for this. By applying FLAMM score, we increase success rate of TOLAC and thereby decrease CS rate in case of previous CS.
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Abstract Objective To obtain cesarean-section (CS) rates according to the Robson Group Classification in five different regions of Brazil. Methods A descriptive epidemiological study using data from secondary birth records fromthe Computer Science Department of the Brazilian Unified Health System (Datasus, in Portuguese) between January 1st, 2014, and December 31st, 2016, including all live births in Brazil. Results The overall rate of CSwas of 56%. The sample was divided into 11 groups, and vaginal births were more frequent in groups 1 (53.6%), 3 (80.0%) and 4 (55.1%). The highest CS rates were found in groups 5 (85.7%), 6 (89.5%), 7 (85.2%) and 9 (97.0%). The overall CS rate per region varied from 46.2% in the North to 62.1% in the Midwest. Group 5 was the largest obstetric population in the South, Southeast and Midwest, and group 3 was the largest in the North and Northeast. Group 5 contributed the most to the overall CS rate, accounting for 30.8% of CSs. Conclusion Over half of the births in Brazil were cesarean sections. The Midwest had the highestCS rates,while theNorth had the lowest. The largestobstetric population in the North and in the Northeast was composed of women in group 3, while in the South, Southeast and Midwest it was group 5. Among all regions, the largest contribution to the overall CS rate was from group 5.
Resumo Objetivo Identificar as taxas de cesárea de acordo com a Classificação de Robson nas cinco regiões do Brasil. Métodos Estudo epidemiológico descritivo utilizando dados secundários obtidos do Departamento de Informática do Sistema Único de Saúde (Datasus) entre 1° de janeiro de 2014 e 31 de dezembro de 2016, incluindo todos os nascidos vivos no Brasil. Resultados Cesáreas representaram 56% de todos os nascimentos. A amostra foi dividida em 11 grupos, e partos vaginais forammais frequentes nos grupos 1 (53,6%), 3(80,0%) e 4 (55,1%). As maiores taxas de cesárea foram encontradas nos grupos 5 (85,7%), 6 (89,5%), 7 (85,2%) e 9 (97,0%). A taxa geral de cesárea variou de 46,2% no Norte a 62,1% no Centro-Oeste. O grupo 5 representou a maior população obstétrica no Sul, Sudeste e Centro-Oeste, e o grupo 3, no Norte e Nordeste. O grupo 5 contribuiu mais para a taxa geral de cesárea, totalizando 30,8%. Conclusão Mais da metade dos nascimentos no Brasil ocorreu por cesárea. O Centro- Oeste apresentou a maior taxa, e o Norte, a mais baixa. A maior população obstétrica no Norte e no Nordeste foi o grupo 3, enquanto no Sul, Sudeste e Centro-Oeste foi o grupo 5. Entre todas as regiões, amaior contribuição para a taxa geral de cesárea foi do grupo 5.
Subject(s)
Humans , Female , Pregnancy , Cesarean Section/statistics & numerical data , Brazil/epidemiology , Cross-Sectional Studies , Vaginal Birth after Cesarean/statistics & numerical data , Labor, Induced/statistics & numerical dataABSTRACT
Background: In a well-equipped hospital, trial of vaginal delivery is done in selected cases of previous C-section (CS). Epidural analgesia administration has been proved to be good adjunct in trial of labor after caesarean (TOLAC).Methods: This study is a prospective observational study done in a tertiary care institution in Tamil Nadu from May 2019 to July 2019. 50 cases with previous history of one CS were selected. Single ton pregnancy, previous transverse lower segment cesarean section admitted cases with adequate pelvis with no other co-morbidities were selected. Epidural analgesia was administered once mother was in established labor. TOLAC was continued till satisfactory progress and emergency repeat caesarean was taken in case of Suspected scar dehiscence (SSD) or abnormal fetal heart rate tracings. Quantitative data was expressed in mean and standard deviation. For qualitative data percentage was used.Results: In 50 cases observed the mean age of the cases was 26±3.64 years. TOLAC was successful in 41 (82%) mothers out of 50. The mode of delivery in 41 TOLAC mothers was found to be forceps in 18 cases (36%) and ventouse delivery 18 cases (36%). Only 9 cases had needed emergency CS (18%). The major indication for CS in TOLAC was found to be fetal distress in 4 number of cases (8%). 43 babies delivered were healthy, 6 babies (12%) admitted in NICU.Conclusions: With the application of epidural analgesia on attempted vaginal delivery in previous cesarean, vaginal delivery was 82% cases.
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Background: Recent years have witnessed a rise in rate of primary caesarean section (CS). No. of women reporting with a previous CS scar is also increasing. Judicious trial of labor in such patients can prevent repeat caesarean section. Aim of this study was to assessing the safety and success rate of vaginal birth after caesarean (VBAC) in selected cases of patients who have undergone previous lower segment CS (LSCS) is the main aim of this study.Methods: In this prospective observational study carried out in a tertiary care teaching hospital over a period of 1 year. 375 pregnant women with a history of one previous LSCS for non-recurrent indications were enrolled. The statistical technique of t-test was administered for relative comparison with respect to maternal and neonatal complications across the two groups, i.e. repeat LSCS and vaginal delivery.Results: Out of 375 patients 187 patients (49.9%) underwent elective LSCS for recurrent indication and for non-recurrent indication associated with some complicating factor. Trial of labor in 188 (50.10%) was given out of which 59.3% had spontaneous vaginal delivery,7.20% had instrumental delivery and 33.50% landed into emergency CS. Commonest cause of Em. LSCS being Fetal distress. As regards maternal complications, no statistically significant difference was found between the Repeat LSCS and Vaginal delivery groups (t = 0.779, p > 0.05). On similar lines, there was no statistically significant difference across both groups as regards neonatal complications (t = 0.632, p > 0.05).Conclusions: Taking into account the increased trend of primary CS, trial of VBAC in selected cases is very important. It can be concluded that VBAC has chances of success in cases with previous one LSCS but it must be carefully investigated and monitored.
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<p><b>Background</b>In the mainland of China, the trial of labor after cesarean section is still a relatively new technique. In this study, we aimed to investigate the effects of labor onset, oxytocin use, and epidural anesthesia on maternal and neonatal outcomes for vaginal birth after cesarean section (VBAC) in a tertiary hospital in China.</p><p><b>Methods</b>This was a retrospective study carried out on 212 VBAC cases between January 2015 and June 2017 in Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Relevant data were acquired on a form, including maternal age, gravidity and parity, body mass index before pregnancy, weight gain during pregnancy, type of labor onset, gestational age, the use of oxytocin and epidural anesthesia, birth mode, the duration of labor, and neonatal weight. The factors affecting maternal and neonatal outcomes for cases involving VBAC, especially with regards to postpartum hemorrhage (PPH) and fetal distress, were evaluated by univariate analysis and multivariable logistic regression.</p><p><b>Results</b>Data showed that 36 women (17.0%) had postpartum hemorrhage (PPH) and 51 cases (24.1%) featured fetal distress. Normal delivery took place for 163 infants (76.9%) while 49 infants (23.1%) underwent operative vaginal deliveries with forceps. There were 178 cases (84.0%) of spontaneous labor and 34 cases (16.0%) required induction. Oxytocin was used in 54 cases (25.5%) to strengthen uterine contraction, and 65 cases (30.7%) received epidural anesthesia. The rate of normal delivery in cases involving PPH was significantly lower than those without PPH (61.1% vs. 80.1%; χ = 6.07, P = 0.01). Multivariate logistic analysis showed that the intrapartum administration of oxytocin (odds ratio [OR] = 2.47; 95% confidence interval [CI] = 1.07-5.74; P = 0.04) and birth mode (OR = 0.40; 95% CI = 0.18-0.87; P = 0.02) was significantly associated with PPH in VBAC cases. Operative vaginal delivery occurred more frequently in the group with fetal distress than the group without (49.0% vs. 14.9%, χ = 25.36, P = 0.00). Multivariate logistic analysis also revealed that the duration of total labor (OR = 1.01; 95% CI = 1.00-1.03; P = 0.04) and the gestational week of delivery (OR = 1.08; 95% CI = 1.05-1.11; P = 0.00) were significantly associated with fetal distress in VBAC.</p><p><b>Conclusions</b>The administration of oxytocin during labor and birth was identified as a protective factor for PPH in VBAC while birth mode was identified as a risk factor. Finally, the duration of total labor and the gestational week of delivery were identified as risk factors for fetal distress in cases of VBAC. This information might help obstetricians provide appropriate interventions during labor and birth for VBAC.</p>
Subject(s)
Adult , Female , Humans , Pregnancy , China , Gestational Age , Labor Onset , Odds Ratio , Oxytocin , Therapeutic Uses , Retrospective Studies , Tertiary Care Centers , Vaginal Birth after CesareanABSTRACT
Objective To explore the appropriate approach of delivery after cesarean section of Uyghur women in primary hospitals in Xinjiang Uyghur Autonomous Region.Methods A total of 5 154 women delivered in Luopu County People Hospital,Hetian Prefecture,Xinjiang Uyghur Autonomous Region from January 2011 to December 2012.Among them,178 Uyghur women had cesarean section history.The interval between the previous cesarean section and this delivery varied from 1 year to 17 years.The number of cases attempting vaginal labor and the indications of the previous cesarean section were recorded.The indications for the second cesarean section were analyzed.The gestational weeks at delivery,blood loss in 2 hours after delivery,neonatal birth weight,newborn asphyxia,the rate of postpartum fever (≥38 ℃) and hospitalization days were compared between the two approaches of delivery.Results (1) Among the 178 cases,119 cases attempted vaginal labor,the rate of attempting vaginal labor was 66.9％ (119/178).A total of 113 cases succeeded in vaginal delivery (the vaginal delivery group),with the successful rate of attempting vaginal delivery of 95.0％ (113/1 19),and the successful rate of vaginal delivery was 63.5％ (113/178).For those 119 women succeeded in vaginal delivery,the indications of the previous cesarean sections were as following:pregnancy complications (68.1％,81/119),macrosomia(5.0％,6/119),dystocia (14.3％,17/119),pregnancies complicated with other diseases(5.0％,6/119) and cesarean section on maternal request(7.6％,9/119).(2) 15 cases in the cesarean section group had postpartum hemorrhage,with the incidence of 13.3％(15/113).The mean total labor time was (507± 182) minutes.6 cases attempting vaginal delivery failed and turned to cesarean section.(3) 59 cases received the second cesarean section (the cesarean section group).The rate of second cesarean section was 33.1％ (59/178).The indications of the second cesarean section were as following:contracted pelvis (5％,3/59),pregnancy complications (42％,25/59),macrosomia (20％,12/59),short interval between the two cesarean sections(≤2 years); (12％,7/59) and cesarean section on maternal request (20％,12/59).(4) Gestational weeks at delivery,rates of newborn asphyxia in the vaginal delivery and cesarean section groups showed no significant statistical difference (P＞0.05).In the vaginal delivery group,the average blood loss in 2 hours after delivery was (259±213) ml,the rate of postpartum fever was 10.6％,the mean fetal birth weight was (3 272±477)g and the mean hospitalization was (1.8±1.6) d.In the cesarean section group,they were (400±320)ml,54.2％,(3 539±500)g and (8.7±2.2)d,respectively.There was significant statistical difference (P＜0.01) between the two groups.Conclusions Vaginal delivery after cesarean section could be attemped in Uyghur pregnant women in Xinjiang primary hospitals,if doctors could choose the indications strictly and monitor closely.These could increase the success rate and safety of vaginal delivery and therefor reduce the cesarean section rate.