RESUMO
The objective of this study is to compare the impact of the different types of the last delivery [CS, instrumental and NVD] on the time-to-conceive [and in particular since when the couple planned for pregnancy], and the effect on subsequent mode [and outcome] of delivery. The two main study groups were patients with secondary infertility [group I] and multiparous pregnant women [group II]. The last delivery in group I was caesarean section [CS] in 64.28% of patients, instrumental vaginal delivery [IVD] in 23.12% of patients and spontaneous vaginal delivery [SVD] in 12.58% of patients. In group II the median time-to-pregnancy following CS was 44.33 months, a time period that was significantly longer than that observed following IVD [24.00 months] and the latter was significantly longer than that observed following SVD [22.46 months]. However, if the median time-to-pregnancy was calculated only from since when the partners decided for a further pregnancy, the corresponding figures were 40.08 months following CS, 12.12 months following instrumental vaginal delivery and 9.59 months following SVD [the corresponding comparisons were significant too]. The success rate of trial of vaginal delivery after a previous LSCS [group II, A] was 79.72% . Most of these vaginal deliveries [95.25%] were unassisted ones. Although the rate of vaginal delivery after CS was reasonably high, it was significantly higher in the IVD group [88%] and in the SVD group [90.04%]. It can be concluded that caesarean delivery adversely affects women's future fertility [secondary infertility becomes more common and time-to-conceive may become longer]. Obstetricians should consider the overall reproductive outcome for an individual woman, should be encouraged to conduct trial of scar and should be retrained in the arts of vaginal breech delivery, external cephalic version and instrumental delivery. Trial of scar is safe and has a high success rate