Management of pregnancy with previous lower segment caesarean section in Modern obstetric practice

Objective: In today’s obstetric practice we encounter increasing number of post caesarean pregnancies because of rise in primary caesarean due to multi factorial reasons. There is increasing concern by obstetricians for managing these cases for medical and legal point of view. Present study was undertaken to decide appropriate mode of delivery and to conduct the proper management of patients with previous lower segment caesarean section. Study design: This is a prospective study carried out on 50 women with previous lower segment caesarean section. From December 2010 to December 2012 at private hospital Ahmedabad. Patient enrolled in study are with previous lower segment caesarean section (classical CS), Inverted T incision other medical complications (Hypertension, diabetes mellitus, anemia, heart disease, cardiac disease patients excluded.) Patients were evaluated thoroughly by history and examination and mode of delivery was decided. Informed consent was taken of the patients who were fit for VBAC (Vaginal Birth after caesarean section). Women who were given trial of VBAC, they progressed into labour spontaneously. Labour was constantly supervised by competent staff and meticulously monitored by cardiotocography. Results and discussion: ? Out of 50 cases, 40 (80%) patients had history of previous 1 cesarean section, 8(16%) patients had history of previous 2 cesarean section and 2 (4%) had history of previous 3 cesarean section. ? Number of previous cesarean section has an important effect on outcome of labour as number of previous cesarean section increases, a repeat LSCS increases. ? Amongst 8 (16%) patients with history of previous 2 LSCS and 2(4%) patients with previous 3 LSCS, repeat LSCS was done in all 10 patients as there is no policy to give trial in patients of previous two or more caesarean sections. ? In present study, out of 40 patients with history of previous 1 cesarean section, in 20 patients repeat LSCS was done without giving trial of labour. Out of 20 patients who were given trial of labour, 12 patients had vaginal delivery and repeat LSCS was done in 8 patients ? Out of 50 patients, 12 patients delivered with vaginal delivery while 38 patients underwent repeat LSCS. ? Repeat LSCS rate is higher due to trend towards less trial of labour and early decision of repeat LSCS. ? Indication of previous LSCS plays an important role in taking decisions and an outcome in present pregnancy. Patients with non-recurrent indication had more chance of delivering vaginally as compared to those with recurrent indications. ? In present study, commonest indication for repeat LSCS was previous two LSCS followed by CPD and fetal distress. ? Vaginal delivery is more likely when there is past history of vaginal delivery before and after previous LSCS. ? Abandoning of a trial was mainly due to fetal distress and non-progress of labour in majority of cases. Conclusion: ? For successful delivery after a previous cesarean section, the obstetrician requires to have the expertise to carefully select the patients, for trial of vaginal birth because rupture of scar can endanger the life of the mother and the child. ? VBAC should be considered in cases of previous one caesarean section done for non recurrent indications. Repeat LSCS rate is higher due to trend towards less trial of labour and early decision of repeat LSCS