Factors Predicting the Outcome of Trial of Labor After Prior Caesarean Section in the Gynecology-Obstetrics Service of the Provincial Hospital Cherif Idrissi, Kenitra, Morocco
Journal Title: ASIAN JOURNAL OF NATURAL & APPLIED SCIENCES - Year 2015, Vol 4, Issue 3
Abstract
The aim is to find out whether the trial of labor after prior caesarean section increases the risk of rupture and whether it has an influence on the foetal and maternal prognosis. A retrospective study of 224 cases of trial of labor was conducted from 01/04/2011 to 30/09/2011, in the Cherif Idrissi Provincial Hospital which is located in the Gharb Chrarda Bni Hssen Region in Morocco. The data was collected from patient folder. Among the studied cases, we registered 77 cases with scarred uterus due to previous caesarean section (34% of all cases). The success rate of vaginal delivery was 71%, 60 % and 40% respectively in less than 30 years age group, 30-35 years age group and more than 35 years age group. These percentages were respectively 89 %, 78% and 47 % in patients who had experienced childbirth by vaginal delivery. Furthermore, the trial of labor led to vaginal delivery in 56% of scarred uterus cases, the highest rate of vaginal delivery success was observed in most multiparous mothers (OR=3.7; CI95% = 1.32-10). Nevertheless, no uterus rupture and no deaths were registered in giving birth patients with previous caesarean section. Moreover, the failure rate of vaginal delivery after caesarean section was significantly higher in obesity grades II and III (78% and 82% ; p<0.05). On the other hand, low failure rate and low intrauterine mortality were observed in patients with grade III of obesity with no caesarean experience (43%; p<0.01). The cephalic presentation appeared like a protector factor whereas twin pregnancy and macrosomia seem to display the same risk of vaginal delivery failure (p<0.01). The present work showed that gemellarity, macrosomia and obesity would be risk factor of the failure of vaginal delivery in patients with caesarean section history. However, multiparity seems to protect from this failure.
Authors and Affiliations
Mohamed EL Bakkali, Amine Arfaoui, Younes Azzouzi, Nabil Ait Ouaaziz, Farid EL Khlifi, Abdelrezzak Khadmaoui
Keywords
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