To determine the outcome of trial of labor after previous one caesarean section due to non-recurrent cause and evaluate the maternal and perinatal mortality and morbidity after trial of scar.
Descriptive study. It was conducted in Obstetrics and Gynaecology Unit - 1, Civil Hospital Karachi from January 2003 to January 2004. The selected subjects in our study were the women with previous one caesarean section due to non-recurrent cause. Singleton pregnancy, adequate pelvis, spontaneous onset of labor were the criteria for trial of labor. The total number of 3612 deliveries were conducted during this study period, whereas, 2624 patients were delivered by caesarean section. Out of these 84 patients formed the cohort, where 34 had elective lower segment caesarean section [LSCS] and 50 were found suitable for trial of scar. Fifty patients underwent trial of labor; of whom 31 had successful vaginal delivery. The success rate was 62% while 19 [38%] patients delivered by repeat caesarean section due to failed trial of scar. The 42.10%of patients had caesarean section due to unsatisfactory progress of labor; 26.31% due to fetal distress, whereas 15.78% patients had caesarean section due to scar tenderness but there was only one partial scar dehiscence that was noticed during operation.10.5%patients had non-progress and fetaldistress at the same time. Out of 31 patients who were delivered after successful trial, 70% had spontaneous vertexdelivery, 16.2% by forceps vaginal delivery, 9.6% by vacuum extraction and one patient who had breech presentation, delivered by assisted breech vaginal delivery. There was no maternal death or rupture of uterus in our study, nor any perinatal morbidity or mortality recorded. Only one case of scar dehiscence was seen during emergency LSCS, which was not associated with any complication. A trial of labor in selected patients with previous one caesarean section is the reasonable option, if patients are carefully selected and monitored
Ghufrana Umer Memon ,Ghazala Ahmed Azam ,
Vaginal birth after caesarean section,
J. Surg. Pak. Int. 2005;
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