1. Rahat N. Qureshi 2. Erum Khalid 3. Nasreen Hameed

1.  Assoc. Prof. of Obs and Gynae, Aga Khan University Hospital, Karachi 

2.  Asstt. Prof. of Obs and Gynae, Hamdrad University Hospital, Hamdrad University Hospital, Karachi 

3.  Sen. Consultant Gynaecologist, CDG, Lahore 

ABSTRACT

Objective: The purpose of this study was to assess the antenatal and intrapartum factors influencing the success of vaginal delivery in women with one cesarean section. Identification of modifiable risk factors which could help in developing local guidelines to improve the management and success rate of patients undergoing vaginal delivery after one previous cesarean section.  Study Design:  Prospective cohort study

Place and Duration of Study: This study was carried out at the Department of Obstetrics and Gynecology, Aga Khan University, Hospital, Karachi from 01.01.2008 to 30.06.2008.

Materials and Methods: A sample size of 21 women, undergoing induction of labor (IOL) and 54 women with spontaneous labor were needed. All women with singleton, cephalic, term pregnancies with history of previous one caesarean section were included. Data collected through the Performa and statistical analysis performed using the SPSS computer statistics programme. To compare proportions, the  ² test and Fisher’s exact test were used and student-t test were used to compare means.

Results: Both groups were comparable and there was no statistical difference between them, except for the Bishop score which in the  induction of labor (IOL) group was 4 ± 1.54 and in the spontaneous labor group was 5.7 ± 2.18, which is statistically significant  (p value = 0.001). The results suggest that there is no affect of previous vaginal delivery, epidural analgesia, fetal distress and baby’s gender on the outcome of trial of labor (TOL). The rate of successful vaginal birth after cesarean section (VBAC) is not significantly different in the group of IOL and spontaneous labor. 

Conclusion: The current clinical evidence suggests that VBAC is advantageous to the mother and has no adverse effects on the fetus but it is no risk free. It is actually the responsibility of the obstetrician to ensure best care and appropriate management plan.

Key Words: Cesarean section (CS), uterine rupture, trial of labor (TOL), vaginal birth after cesarean section