VAGINAL BIRTH AFTER CAESAREAN SECTION; TO EVALUATE FACTORS FOR SUCCESSFUL OUT COME

Vaginal birth after caesarean section is currently the preferred method of delivery for pregnant women who hadprevious one lower segment caesarean section. This common practice warrants some reconsideration in light of recent clinical data on the risksassociated with VBAC. Objectives: To evaluate conditions which can achieve successful vaginal birth after one caesarean section. StudyDesign: Cross-sectional analytic study. Setting: Department of Obstetrics and Gynaecology, Unit-I, Services Hospital, Lahore. Duration ofStudy with Dates: Study was carried out over a period of six months from 08-06-2006 to 07-12-2006. Subjects and Methods: One hundredpregnant women meeting inclusion criteria were included. During trial of labour patients were closely monitored by vital signs, fetal cardiacactivity, lower abdominal pain and tenderness, fetal distress, vaginal bleeding and loss of presenting part. Results: Mean age of the patientswas 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 vaginaldelivery. 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 moresuccessful in patients 58.0% with favourable Bishop score. Conclusions: BMI <20, prior vaginal delivery, non-recurrent indication for previouscaesarean, spontaneous onset of labour, cervical dilatation or favourable Bishop score, weight of baby < 3.5kg predict an individual’s likelihoodof successful VBAC.INTRODUCTION than 40 years is considered to be a favourable factor3.A dramatic rise in caesarean deliveries have beenoccurring over the past three decades. The old myth of However, trial of labour is associated with a greater risk of“once a caesarean always a caesarean” is no longer uterine rupture and hence increased incidence of acceptable. Hence there is a change world over leading perinatal death4.to on increased practice of attempting vaginal birth after In Pakistan, large scale data is lacking on safety andcaesarean delivery as compared to repeat elective outcome of trial of labour. Two retrospective studiescaesarean delivery include lower rates of post partum conducted in our country suggest success as high as 70-fever, wound infections, maternal discomfort, length of 80% of trial of labour in patients with favourable hospital stay, need of blood transfusion and lower rates of parameters5,6.hysterectomy1.Hence this st