Assessing Success Of Vaginal Birth After Cesarean By FLAMM Model In A Retrospective Observational Design

ABSTRACT

Background: After year 2000 cesareanrates have increased from 15% to 30-50% worldwide. Practice of Trial of labor after cesarean has decreased from last two decades of 20thcentury. Predictors of vaginal birth after cesarean are not uniform and not suitable equally for all populations. FLAMM model was tested in this study for its predictability for a successful vaginal birth after previous one cesarean. Material And Methods:For an observational, retrospective study 72 patient files admitted in 2018 in Obstetric Department of C R Gardi Hospital were included which fulfille d criteria of having second pregnancy after cesarean for non recurrent indications like fataldistress, failure of induction of labor, pre-eclampsia, eclampsia, twins and others. Indication of contracted pelvis, rupture uterus, previous classical cesarean section; and multiple pregnancy, medical complications and obstetric complications in this pregnancywere excluded. FLAMM scoreparameters; cervical dilatation, effacement, presence of previous vaginal birth before cesarean, indication of it and age of woman wereused. Observations of successful and failed trial were done by scoring system. Chi square test was used to compare data. Study variables were success of trial in various FLAMM parameters. Result:Higher scores in cervical dilatation (p<0.001), effacement (p<0.001) and prior vaginal delivery (p=0.03) were significantly associated with a successful outcome. Higher theaggregate FLAMM score, higher were chances of successful trial. A non-recurrent indication other than non-progress of labor for previous cesarean had no statistical association with success of trial. Aggregate score of 6 and more has 100 % predictability for a successful vaginal birth. Conclusion:Prediction by FLAMM model resulted in 62. 5%successful trial. FLAMM model maybe used for near to accurate prediction of successful trial of labor after cesarean.