Pregnancy outcome in women with one previous caesarean delivery in Lagos University Teaching Hospital: A five-year review

Abstract

Background: Women in developing countries have aversion for caesarean delivery. Those with one previous caesarean section sometimes have the option of proceeding with a trial of labour or planned repeat caesarean section (CS) in a subsequent pregnancy. While each option has its own attendant risks and benefits, decision making on the route of delivery should be individualised considering indication for the previous CS, obstetrics risk factors, patient's choice, facilities and expertise available. Aim: This study aims to determine the pregnancy outcome in women with one previous caesarean section in Lagos University Teaching Hospital. Method: This was a retrospective study of pregnancy outcome in women with one previous caesarean section managed in Lagos University Teaching Hospital between January 2010 and December 2014. Information was obtained from the case notes, labour ward and theatre records. Those women with previous classical caesarean section or prior uterine surgery were excluded. The collected data were analysed using SPSS software version 23. Result: There were 498 women fulfilling the eligibility criteria for this study out of 9,740 deliveries during the study period. The success rate of vaginal birth after caesarean section (VBAC) was 24.30%, elective caesarean section was 17.1% and emergency caesarean section was 58.63%. There were 11(10.8%) cases of scar dehiscence and 67(65.7%) cases of failure to progress in labour. No significant maternal and perinatal morbidity was observed in our study population. VBAC rate was significantly higher in women who had prior vaginal deliveries, especially in those with previous VBAC. Conclusion:In carefully selected cases, trial of scar (TOS) after a prior caesarean is safe and often successful. A prior vaginal delivery, particularly, a prior VBAC is associated with a higher rate of successful VBAC.