Maternal and neonatal outcome in patients with vaginal birth after cesarean section (VBAC)

Objective: The aim of study is to know the maternal and fetal outcome in the present pregnancy of patients with previous one caesarian section (CS).Methodology: A prospective study was undertaken to know the neonatal and maternal outcome in patients admitted with previous cesarean section for the period of 1 yr and 9 months from October 1998 to June 2000.Vaginal delivery were monitored and failed trial cases were taken for repeat CS.Maternal and neonatal outcome was studied in the VBAC and repeat CS cases.Results: Among the total 14164 admissions to labour ward, there were 942 patients with previous CS (14.87%).Elective CS was done for 530 cases and 412 cases were planned for trial of labour and out of them 311 had vaginal deliveries, with success of vaginal birth after cesarean (VBAC) of 75.48%.There were 5 cases of rupture uterus and subtotal hysterectomy was done in 3 cases and closure of rent was done in 2 cases.Repeat CS was done in 96 cases.Neonatal outcome in VBAC babies was, 83.28% healthy, 7.72% had morbidity and admitted to neonatal intensive care unit (NICU) and 9% had mortality.Neonatal outcome in repeat CS were normal in 32.3%, morbidity and admission to NICU was 41.66% with a mortality of 26.04%.Maternal mortality occurred in 2 unbooked patients, 1 was associated with asthama and COPD, another with severe anemia with scar rupture.Conclusion: VBAC is more successful in cases with previous non recurrent indications.Vigilance regarding the indication of primary CS, proper patient selection and counseling for trial of scar, careful observation throughout in a well equipped unit are key to reducing CS rate.Keywords: Cesarean section (CS), vaginal birth after cesarean section (VBAC), NICU, perinatal morbidity and mortality, subtotal hysterectomy.Cesarean section (CS) is an operation mainly evolved to save a maternal life during difficult childbirth, has now become increasingly the procedure of choice in high risk situations to prevent neonatal morbidity and mortality.This alarming rise has been a matter of concern to the profession and public 1 .Planned vaginal birth after cesarean section (VBAC) is appropriate for and may be offered to the majority of women with singleton pregnancy of cephalic presentation at 37+0 wks or beyond who have had previous lower segment cesarean delivery, with or without a history of previous vaginal birth 2 .VBAC is recommended after one CS, but preferably not after second CS, as it increases maternal morbidity and mortality.The rates of CS are rising all over the world.