P. Thulasi1, Rebecca Ratnam2
OBJECTIVES OF THE STUDY
1. To identify maternal and foetal factors responsible for the success or the failure of VBAC.
2. To study maternal and perinatal outcome while giving a trial of scar.
METHOD OF COLLECTION OF DATA
Study was conducted at P K Das Institute of Medical Sciences hospital. 50 cases obtained during the period of January 2013 to December 2013 were studied.
1. Multigravida with previous one lower segment caesarean section at term in early labour.
2. Singleton pregnancy.
3. Cephalic presentation.
4. Who are willing for VBAC.
5. Well-informed subjects.
1. Known classical scar and 2 or >caesarean sections.
2. Unknown uterine scar.
3. Multiple gestation.
5. Cephalopelvic disproportion.
6. Subjects with medical complication/obstetric risk factors.
Cases are monitored with a partogram and continuous foetal monitor.
Informed consent is taken after explaining the risks, benefits and potential complications in patients’ own language while giving a trial of scar. After the exclusion criteria, patients selected for VBAC is given a trial of scar.
1. Maternal monitoring of blood pressure and pulse rate every 15 minutes is done.
2. Continuous foetal monitoring in the active phase of labour.
3. Contraction stress test will be done in the active phase of labour. Uterine contractions are monitored every 30 minutes. Partogram is used to ensure adequate progress with respect to descent of the head, cervical dilatation, moulding and caput.
4. Pelvic examination every one hour to assess the progress of labour.
5. If labour has to be induced, done with great care particularly with prostaglandins – PGE 2 gel. Progress of labour should be assessed by a senior obstetrician, particularly in an unfavourable cervix.
6. Cross-matched blood is kept ready and a good intravenous line is established.
7. Oxytocin may be used with caution, as in any labour, for induction or augmentation.
8. Epidural analgesia can be used.
9. Ventouse or outlet forceps is kept ready to cut short second stage of labour.
10. Operation theatre is kept ready to deal any emergency caesarean section.
11. Anaesthetist and paediatrician to be available while giving a trial of scar.
12. Post-partum digital exploration of caesarean scar done only if persistent bleeding, hypotension and tachycardia are present. Senior obstetrician to be available all the time while giving trial of scar.
A total of 50 cases for the study was selected. Among that 46(92%) patients were in the age group 20-30 years There were no patients below 145 cm. 39(78%) patients were gravida 2. All of them were para-1, 34 patients (68%) had emergency LSCS in previous pregnancy. whereas 16 patients (32%) had elective LSCS. Post-operative period was uneventful among 94% patients. 3 patients (6%) had post-operative morbidity after LSCS 34 patients (68%) cervical dilatation less than 3 cm. Oxytocin augmentation were 3 cases. 46 patients (92%) had spontaneous onset of labour, whereas 4 patients (8%) were induced with Cerviprime. Among the induced cases, 3 had repeat LSCS. Among the spontaneous onset of labour cases, 7 had repeat LSCS among 46 patients (92%). Post-operative periods were uneventful. 3 patients (6%) had fever. 40 patients (80%) had successful VBAC.
Success of VBAC depends on the proper selection of the cases, provided senior obstetrician, anaesthetist, emergency OT, and fresh cross-matched blood as well as paediatrician also available.