Vaginal Birth After Caesarean Section

Abstract

Introduction: Vaginal birth after caesarean section is currently the preferred method of delivery for pregnant women who had previous one lower segment caesarean section. This common practice warrants some reconsideration in light of recent clinical data on the risks associated with VBAC. Objectives: To evaluate conditions which can achieve successful vaginal birth after one caesarean section. Study Design: Cross-sectional analytic study. Setting: Department of Obstetrics and Gynaecology, Unit-I, Services Hospital, Lahore. Duration of Study with Dates: Study was carried out over a period of six months from 08-06-2006 to 07-12-2006. Subjects and Methods: One hundred pregnant women meeting inclusion criteria were included. During trial of labour patients were closely monitored by vital signs, fetal cardiac activity, lower abdominal pain and tenderness, fetal distress, vaginal bleeding and loss of presenting part. Results: Mean age of the patients was 34.27 + 6.45. According to distribution of cases by parity, maximum number i.e 64 (64.0%) was P 3-6. 79 patients (79.0%) had prior vaginal delivery. Maximum 41.0% patients were due to fetal distress while in 28% indication for previous caesarean were breech presentation. In 71% patient membranes were intact while 29.0% patients presented with per vaginal leaking. 51.0% had dilatation between 3-4cm. VBAC was more successful in patients 58.0% with favourable Bishop score. Conclusions: BMI <20, prior vaginal delivery, non-recurrent indication for previous caesarean, spontaneous onset of labour, cervical dilatation or favourable Bishop score, weight of baby < 3.5kg predict an individual’s likelihood of successful VBAC.