A comparative study of maternal and fetal outcome in trial of labour after caesarean section and elective repeat cesarean section
Journal Title: International Journal of Medical and Health Research - Year 2018, Vol 4, Issue 9
Abstract
Background: Caesarean section is one of the commonest operations performed on childbearing women, with rates continuing to rise worldwide. Previous caesarean delivery is one of the most common indications for repeat caesarean delivery. One of the strategies proposed to reduce the rate of caesarean section is Trial of Labour (TOL). For women who have had a previous caesarean, choice for mode of birth in their next pregnancy is either a Trial of Labour after Caesarean (TOLAC) or an Elective Repeat Caesarean Section (ERCS).. Both ERCS and trial of labour have benefits and harms. The risks of TOL when compared with ERCS include haemorrhage, need for blood transfusion, endometritis, uterine rupture, perinatal death, and hypoxic ischaemic encephalopathy. Materials and methods: A comparative study of women with term gestation with singleton pregnancy, who underwent one caesarean section after considering inclusion and exclusion criteria were included in this study. A total of 90 cases were selected either from the outpatient department (booked) or in labour room (un booked). The study population was divided into 2 groups, 45 in each group. The patients who planned ERCS were put in one group and patients who underwent TOL in another group. Demographic data, details of obstetric history, intrapartum events and postpartum events were recorded. Results: There were 1250 births during the study period. Among the 90 women who had a singleton gestation and a history of caesarean delivery, 45 under went a trial of labor and 45 had an elective repeated caesarean delivery who had indications for a repeated operation. The rate of uterine rupture was 4.5% in the TOL group and nil in ERCS group. The uterine dehiscence was 29.5%in TOL group as compared to 10.8% in the ERCS group. Augmentation of labor with oxytocin and induction of labor, regard less of method, were associated with a significantly greater risk of uterine rupture than was spontaneous labor without the use of oxytocin. Conclusion: Trial of labor for women with a history of caesarean delivery is associated with an increased risk of adverse perinatal outcomes and a higher rate of maternal adverse events, as compared with elective repeat caesarean delivery.
Authors and Affiliations
Dr. PB Jaju, Dr. Anvesha Kumar
Keywords
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