The Maternal and Perinatal Outcome of Vaginal Birth after Caesarean Section at Al Yarmouk Teaching Hospital in Baghdad
Abstract
ABSTRACT
Background: Rates of primary Caesarean section have increased over the last 20 years. Consequently, increasing numbers of women present with second pregnancy and face the issue of the mode of delivery.
Objectives: To identify the maternal and perinatal outcome of a trial of labor in women after one low transverse Cesarean delivery and no prior vaginal deliveries.
Methods: A cross-sectional descriptive study of women with one low transverse Caesarean delivery in their first pregnancy who delivered their next pregnancy at Al Yarmouk Teaching hospital for a period of two years from the 1st of January 2011 to the end of December 2012. Maternal and perinatal outcomes were reviewed to assess the possible morbidity that might be associated with vaginal birth after Caesarean section attempt.
Results: Of 735 women given trial for vaginal birth after Caesarean section, 512 (69.7%) were successful, 223 (30.3%) were unsuccessful and ended with emergency Caesarean section. The maternal complications among those who had successful VBAC were as follows: postpartum hemorrhage 2.3%, febrile morbidity 1.9%, vaginal tears requiring repair under anesthesia 0.96%, cervical tears 0.39%, ruptured uterus 0.19%, hysterectomy 0.19%. The maternal complications among those who had un successful VBAC and delivered by emergency caesarean section were as follow: febrile morbidity 9.86%, postpartum hemorrhage 4%, anesthetic complications 1.79%, scar dehiscence 1.79%, bladder injury 1.34%, ruptured uterus 0.89%, thromboembolism 0.89%, hysterectomy 0.44%. The perinatal complications among those who had successful vaginal delivery were as follow: respiratory distress syndrome 1.95%, meconium staining 1.5%, birth asphyxia 0.78%. The perinatal complications among those who delivered by emergency Caesarean section were as follow: respiratory distress syndrome 5.38%, meconium staining 4.93%, birth asphyxia 2.24%, fetal death 0.44%.
Conclusion: Successful vaginal delivery achieved in 69.7% of women with a single prior low transverse caesarean delivery and no prior vaginal deliveries. Successful vaginal birth after Caesarean section had maternal and perinatal morbidity less than that of unsuccessful one.
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