Vol. 5, Issue 7 (2019)
Clinical evaluation of spontaneous and induced vaginal birth after caesarian delivery in pregnant females from Bihar regions
Author(s): Dr. Vijaya, Dr. Sunita Kumari
Abstract: Before 1970s the phrase “once a caesarean, always a caesarean” dictated obstetric practice. Later because of escalating rates of caesarean section (CS) suggestions were made that vaginal birth after CS (VBAC) might help in reducing the rates of CS. So trial of labour in cases of previous CS (PCS) has been accepted as a way to reduce the overall CS rates. There is evidence of safety of trial of labour, with or without induction of labour, with reduction in iatrogenic prematurity, and maternal morbidity and mortality. VBAC is believed to be appropriate for most women with a history of low transverse CS. However several factors increase the likelihood of a failed trial, which in turn might lead to increased maternal and perinatal morbidity including uterine rupture and related fetal morbidity and mortality rates. The purpose of this study was to identify the obstetrical parameters that influence the success of vaginal delivery in women with previous caesarean section. The present study was planned in Department of Obstetrics and Gynaecology, Jawahar Lal Nehru Medical College, Bhagalpur, Bihar and Patna Medical College Patna. A total 250 women with singleton live pregnancy of >34 weeks of gestational age with previous one caesarean delivery and willing for vaginal birth after caesarean (VBAC) were enrolled in the study. No attempt was made to screen candidates based on relative likelihood of success. Each patient was counselled about the risks and benefits of undergoing trial of labour and delivering vaginally. Data was analysed by going through the case sheet of each patient The data generated from present study concludes that attempt for VBAC is well justified for post caesarean pregnancies with non recurrent indications. Screening for this should preferably begin at antenatal stage itself to minimize the related risks. Proper selection, appropriate timing and suitable methods of induction with close supervision by competent staff are the key factors to achieve greater degree of success. The ability to predict women who are at high risk for failing trial of labour and those with high probability of successful vaginal delivery would help guide clinicians and women in making good clinical decisions and minimizing adverse events.
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