Analytical Study on Trial of Scar using Flamm and Geiger Admission Scoring System for VBAC

ABSTRACT

Introduction: The strength of the uterine scar and its capacityto withstand the stress of subsequent pregnancy and laborcannot be completely assessed or guaranteed in advance.Hence the present study was undertaken to analyse factorsstated by Flamm and Geiger admission scoring system andother plausible factors for successful TOLAC.Material and methods: A total of 265 cases of a previous CSwere selected. Booked cases were regularly followed up inthe antenatal clinic and the unbooked patients, who reporteddirectly for labor, were then assessed for a trial of vaginaldelivery.Result: A total of 265 cases were eligible for trial of scar usingFlamm and Geiger Admission scoring system. 135 had VBACwhereas in 130 cases trial was terminated and had ERCS.Out of 130 ERCS, 73.4% were because of scar tenderness,whereas 16.4% had non reassuring fetal heart rate. Remaininghad unsuccessful progress of labor.Conclusion: Flamm and Geiger admission scoring systemcan be used to successfully predict the likelihood of vaginaldelivery after a trial of scar, thereby reducing maternal andfetal morbidity and rate of caesarean section. Decisionregarding trial should also include factors like eventfulprevious pregnancy, interpregnancy interval, gestational ageand estimated fetal weight. Successful trial can be increasedby regular antenatal visits, general health promotion, earlydetection and management of high risk factors. Adequate interpregnancy interval should be encouraged by promoting andoffering contraception.