Vaginal Birth After Previous Caesarean Section

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Chro N. Fattah Hazha Jalal


The proportion of women who attempt vaginal birth after prior cesarean delivery has   decreased mainly because of the concern about safety.  The purpose of this study is to observe maternal & neonatal outcomes in women delivered either by vaginal birth after caesarean section, elective repeat caesarean section or failed trial of labour. To design a definite protocol for selection of patient to achieve successful vaginal birth after caesarean (VBAC) section. A prospective observational study was set at Sulaimani Maternity Teaching Hospital/ Kurdistan region of Iraq, from first July 2013 to first July 2014. In which 200 pregnant women (with one prior caesarean section & singleton, term, cephalic presentation) were enrolled, followed up during labour & puerperium for maternal & neonatal complications.  Data analysis was performed using the statistical software namely (SPSS   version 20). Planned vaginal birth was successful in 63.4% of pregnant women, with the least maternal and neonatal complication, apart from 3rd degree perineal tear (2.3%) which was statistically significant (probability value < 0.001). In conclusion, the women who had successful vaginal birth after caesarean, had better result for the mother and neonate than failed trial of labour and those who had elective repeat caesarean section. Women with body mass index of < 30kg/m2, age <30 years, inter pregnancy interval >18months, non-recurrent cause of previous scar and estimated fetal weight of < 4kg, had more successful VBAC rate.


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[1] Royal College of Obstetricians and Gynecologists, “Green-top Guideline. Birth after previous caesarean birth Guideline February,” 2007.
[2] SZ. Wanyoni, SK. Ngichabe, “Safety concern for planned vaginal birth after caesarean section in Sub-Sahran Africa,” BJOG, vol. 121, pp. 141-144, 2014.
[3] BE. Hamilton, JA. Martin & Ventura, “Vaginal Birth After Caesarean,” Natl.Vital Stat Rep, vol. 57, pp. 1–102, 2009.
[4] EJ. Kang, KA. Lee, MH. Park, YJ. Kim, SH. Chun, JJ. Ahn, “Evaluation of the factors affecting the success of the trial of vaginal birth and duration of labor in women with previous cesarean section,” Korean J Obstet Gynecol, vol. 50, pp. 1640-49, 2007.
[5] M. Raida Al-Wazzan, “Factors affecting success of trial of labour after previous one lower segment Caesarean section,” Department of Obstetrics & Gynecology, College of Medicine, University of Mosul, Annals of the College of Medicine, vol. 36 , pp. 121-129, 2010.
[6] A. Aisien, A. Oronsaye, “Vaginal birth after one previous Caesarean section in a tertiary institution in Nigeria,” J Obstet Gynecol, vol.24, pp. 886–90, 2004.
[7] E. Wall, R. Roberts, M, Deutchman, W, Hueston, L. Atwood and B. Ireland, “American Academy of Family Physicians. Trial of labour after caesarean (TOLAC),” Formerly trial of labour versus elective repeat caesarean section for the women with a previous caesarean section ,AAFP Policy Action March, 2005.
[8] 8Society of Obstetricians and Gynecologists of Canada, “SOGC clinical practice guidelines, Guidelines for vaginal birth after previous caesarean birth,” Int J Gynecol Obstet, vol. 89, pp. 319-31, 2005.
[9] S. Chhabra, G. Arora, “Delivery in women with previous caesarean section,” J Obstet Gynecol India, vol. 56, pp. 304-7, 2006.
[10] SK1. Srinivas, DM. Stamilio, MD. Sammel, EJ. Stevens, JF, Peipert, AO. Odibo, et al., “Predicting failure of a vaginal birth attempt after caesarean delivery,” Obstet Gynecol, vol. 109, pp. 800-5, 2007.
[11] M. Dinsmoor, and E. Brock, “Predicting failed trial of labour after primary caesarean delivery,” Obstet Gynecol, vol. 103, pp. 282-6, 2004.
[12] MB. Landon, JC. Hauth, KJ. Leveno, “Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery,” NEJM, vol. 351, pp. 2581–2589, 2004.
[13] F. G. Cunningham, J. Kenneth, L. Steven & B. Williams, “Obstetrics, Twenty-Third Edition, USA, Chapter 26,” vol. 12, pp. 1404, 2010.
[14] JR. Scott, “Avoiding labour problems during vaginal birth after caesarean delivery,” Clin Obstet Gynecol, vol 40, pp. 533-41, 1997.
[15] M. MacDorman, E. Declercq, F. Menacker, “Recent trends and patterns in cesarean and vaginal birth after cesarean (VBAC) deliveries in the United States,” Clin Perinatol, vol.38, pp. 179–92, 2011.
[16] D. Beena, K. James, E. Judith, Glazner, D. Lezotte, , and M. Anne, “Neonatal outcomes after elective caesarean delivery,” University of Colorado school of medicine, 2009.
[17] C. Rossi, D. Vincenzo & Addario, “Maternal morbidity following a trial of labor after cesarean section vs elective repeat cesarean delivery,” University of Bari, Bari, Italy, 2008.
[18] G Barau, P-Y Robillard, TC Hulsy, “Linear association between maternal pre- pregnancy BMI and risk of caesarean section in term deliveries,” University of South Carolina, RCOG, 2006.
[19] P. Ravindu, P. Michael, B, Harris, “Predictors of failed trial of labor among women with an extremely obese BMI,” University of North Carolina, AJOG, 2013.
[20] WH. Huang, DK. Nakashima, PJ. Rumney, KA. Keegan, K. Chan, “Interdelivery interval and the success of vaginal birth after cesarean delivery,” Obstet Gynecol, vol. 99, pp. 41–4, 2002.
[21] E. Bujold, SH. Mehta, C. Bujold, RJ. Gauthier, “Interdelivery interval and uterine rupture,” AJOG, vol.187, pp. 1199–202, 2002.
[22] G., Cynthia, J. Gabor, P. Stone, L. Joanne, “Increased success of trial of labor after previous vaginal birth after cesarean,” The Mount Sinai Medical Center, New York, Department of Obst. & Gyne, 2004.
[23] MR. Lye & EIT. Dellinger, “ Timing scheduled cesarean delivery in patient on a teaching versus private service,” Adherence to American College of Obstetrician & Gynecologists guideline and neonatal outcome, AJOG vol. 193, pp. 377-346, 2006.
[24] Tita, Y. Lai, M. Varner, “Timing of elective cesarean delivery at term and neonatal outcomes,” NEJM, vol. 360, pp.111-120, 2009.
[25] TC. Okeke, N. Onah, LC. Ikeako, “Maternal & fetal outcome of elective caesarean section at 37-38 weeks versus 39 completed weeks of gestation in Enugu, Southeast Nigeria,” University of Nigeria Teaching Hospital, department of Obstet. & Gyn., 2013.
[26] FA. Wilmink, CW. Hukkelhoven, S. Lunshof, BWJ. Mol, JAM. Van der Post, DNM. Papatsonis, “Neonatal outcome following elective cesarean section beyond 37 weeks of gestation: a 7-year retrospective analysis of a national registry,” AJOG, vol. 202, pp. 250, El-8, 2010.
[27] R. Dobson, “Caesarean section rate in England and wale hits,” BMJ, vol. 323, pp. 951a, 2001.
[28] S, Liu, M. Robert, “Maternal Mortality and Severe Morbidity Associated with Low-Risk Planned Cesarean Delivery Versus Planned Vaginal Delivery at Term,” Canadian Medical Association. Journal, Ottawa, vol. 176, pp. 455, 2007.
[29] F. Michael, “Vaginal birth after cesarean Revisited,” NEJM, 2004.
[30] G. Alison, M. David, O. Anthony, “Is vaginal birth after cesarean (VBAC) or elective repeat cesarean safer in women with a prior vaginal delivery?,” Department of Obstetrics and Gynecology, Washington University in, 2006.
[31] O. Georg, A. Chukwuemeka, E. Hyacinth, “Maternal and perinatal outcomes of delivery after a previous cesarean section,” Department of Obtet.& Gyne. University of Nigeria Teaching Hospital, 2014.
[32] L. Simpson, “VBAC: is it worth the risk?,” Contemporary ObGyn, vol. 48, pp. 27–34, 2003.
[33] JM. Guise, MA. Denman, C. Emeis, “Vaginal birth after cesarean: new insights on maternal and neonatal outcomes,” AJOG, vol. 115, pp. 1267, 2010.
[34] Ramachandrappa, L. Jain, “Elective cesarean section: its impact on neonatal respiratory outcome,” Clin Perinatol, vol. 35, pp. 373–9, 2008.
[35] AK. Hansen, K. Wisborg, N. Uldbjerg, TB. Henriksen, “Risk of respiratory morbidity in term infants delivered by elective cesarean section: cohort study,” BMJ, vol. 336, pp. 85–7, 2008.