Evaluation of Mode of Delivery in Women with Previous Caesarean Section

Objectives To identify factors associated with successful Vaginal Birth after Caesarean Section (VBAC) and failed Trial of Labour after Previous Caesarean Section Delivery (TOLAC). To compare maternal& neonatal outcome in women undergoing TOLAC with women undergoing elective repeat caesarean section (ERCS). Material& Methods Study Design Prospective observational study. Study population 200 consenting pregnant women with history of prior single caesarean section carried out at our institute from July 2013 to July 2015. Result Primary outcome noted is the various factors responsible for successful and failed TOLAC. Secondary outcome noted is the comparison between TOLAC and ERCS group (control) in terms of maternal and neonatal morbidity and mortality. Conclusion TOLAC is the preferred option for women presenting with previous single LSCS. Antenatal counseling and informed consent is crucial. It involves individualized assessment of risk and benefit of planned VBAC and ERCS. They should be informed that overall, the chances of successful VBAC are 72-76 %. Successful VBAC has the fewest maternal and paternal adverse effect whiles the greatest risk of adverse outcome occurs with failed TOLAC. VBAC failure can be minimized with appropriate patient selection, good antenatal counseling, careful review of the case notes and adherence to written guidelines.