Trial of scar and vaginal birth after caesarean section

The caesarean section rate has increased to an alarming extent in the last three decades the world over and fear of rupture of uterus in subsequent pregnancy and labour has led to a high rate of repeat caesarean sections. The objective of this study was to determine the final outcome of a trial of scar and Vaginal Birth After Caesarean Section (VBAC) and develop guidelines to reduce the rate of unnecessary repeat caesarean section.

This study was carried out in Obstetric and Gynecology Unit 'A' of Ayub Teaching Hospital Abbottabad from 01.11.2002 to 31.10.2004. A total of 2652 patients were delivered during this period out of which 297 patients had history of one previous caesarean section. A total of 53 patients had an elective repeat caesarean section and rest of 244 was subjected to a trial of scar.

Out of 244 patients selected for trial of scar, 165 (67.2%) had a successful uncomplicated vaginal delivery, 7 (3.2%) were delivered by forceps, 11 (5.2%) with vacuum extractor and 61 (24.4%) required a repeat emergency caesarean section. 83% of the patients had a spontaneous onset of labour and 17% needed induction of labour with prostaglandin E2 pesseries and augmentation of the labour with oxytocin. However repeat caesarean section rate was high in the later group. 71.2% of the babies were born with Apgar score > 8 and 24.6% had an Apgar score between 6-8. There were 3 cases of scar dehiscence and one case of ruptured uterus and one baby was lost due to this complication. No serious maternal complication occurred.

More than 75% of the patients with previous one caesarean section for non-recurrent cause can be successfully delivered vaginally. Antenatal booking and follow up, careful case selection for trial of scar and close observations during labour will achieve successful maternal and perinatal outcome. VBAC also saves any future caesarean sections, as currently previous two caesarean sections is an indication for elective caesarean section.