PROSPECTIVE STUDY OF DELIVERY AFTER PREVIOUS ONE CAESAREAN SECTION AT KING HUSSEIN MEDICAL CENTER

Objective: To evaluate the mode of delivery and safety of vaginal delivery in women with previous caesarean section at King Hussein Medical Centre. Methods: Three hundred thirty women with previous caesarean sections were enrolled into the study. Age, parity and indication for the previous caesarean sections were recorded. All events of labour were also recorded (mode of delivery, apgar scores, birth weight, and duration of oxytocin and prostaglandin use). Intrapartum and postpartum complications were recorded. Analysis of the rate of vaginal delivery was made in relation to parity and the indication for the previous caesarean section. Results: The mean age of women was 29.2 years (19-45). One hundred and twenty six (38%) were Para 1. Overall, the vaginal delivery rate was 71%. Among women who had one previous caesarean section 62% achieved vaginal delivery. Overall 11.8% of women had an elective caesarean section. The highest vaginal delivery rate was in patients who had caesarean section for breech presentation (74%), followed by fetal distress (68%). Even in women, where the previous caesarean section was due to failed progress, 55% achieved vaginal delivery. There was one case of ruptured uterus in the vaginal delivery group, which resulted in a perinatal mortality. The mean birth weight was 3.168 for the vaginal delivery group and 3.4 kg for the caesarean section group. Conclusion: Trial of labour after previous caesarean section can be very successful with vaginal delivery rate reaching 62%. Even when the previous caesarean section was due to failed progress, vaginal delivery was achieved in 55% of cases. Although the risks of vaginal delivery were small in our series, these should not be overlooked when making decisions regarding mode of delivery after previous caesarean section.