Maternal outcome in cases of vaginal deliveries after one Cesarean section

ABSTRACT

To evaluate maternal morbidity and mortality in cases of vaginal deliveries after one prior cesarean section. To reduce repeat cesarean rate in selective cases. To construct guide line for trial of cesarean scar. Descriptive prospective study. Department of obstetrics and Gynecology Unit 1 Civil hospital Karachi. Duration of Study Two years study from 1st October 2005 to 30th September 2007. During two years period women with previous one cesarean delivery due to non recurrent cause were selected. Excluded cases underwent elective cesarean sections. Women with no medical disorder having singleton term pregnancy, vertex presentation and adequate pelvis were enrolled for trial of labour. All the women were allowed to go into spontaneous labour. No augmentation of labour was done. Careful monitoring was done during labour. During two years period One hundred and eighty eight women presented with previous one cesarean section for nonrecurrent cause .Out of one hundred and eighty eight women seventy eight decided to have elective cesarean section for some obstetric reason. One hundred and ten women were selected for study, Out of these One hundred and ten women thirty four [30.9%] ended in emergency cesarean section [Non progress of labour, 41.17%, fetal distress 29.41%, impending rapture 17.64%. where as seventy six [69.09%] women had successful vaginal deliveries. Of sventy six women delivering vaginally twenty [26.31%] women had instrumental vaginal deliveries and fifty two [73.68%] women had spontaneous vaginal deliveries. There was no maternal mortality. No case of uterine rapture occurred. Partial scar dehiscence was found in 2.6% cases. Postpartum hemorrhage occurred in 5.2%cases due to atonic uterus. Duration of hospital stay was 2-3 days following vaginal deliveries where as it was 7-8 days following cesarean section. With well defined protocol, trial of labor after one prior cesarean delivery is safe and most often successful and reduces the rate of repeat cesarean section