Trial of Scar After Cesarean Section A study of 100 cases

Abstract

Objective: To determine the outcome of term pregnancy in patients with previous one lower segment caesarean section. Study Design: A descriptive study conducted in Department of Obstetrics and Gynaecology, Unit 1, Fatima Memorial Hospital, Lahore, from June 2011 to December 2011. Materials and Methods: One hundred patients according to inclusion criteria were studied. Written informed consent was taken, thorough history, abdominal and pelvic examinations were done and patients were closely monitored for uterine rupture by monitoring pulse and blood pressure, fetal heart sounds, lower abdominal pain, vaginal bleeding and loss of presenting part. Partogram was maintained to assess the progress of labor and fetal monitoring was done by electronic fetal monitors. Results: Among 100 patients 64% had vaginal delivery while 35% had repeat caesarean section. Out of 64 patients 41(64%) had spontaneous vaginal delivery, 10(15%) had vacuum delivery and in 13 patients (20%)forceps were applied. 1 unbooked patient had uterine rupture receiving trial of scar in periphery and the most common indication for repeat caesarean section was failed progress of labor (54%). Maternal morbidity (45%) in terms of prolonged hospital stay, infection and febrile illness was seen more in operative group. Conclusion: This hospital based study shows that trial of scar is safe in carefully selected patients and the success rate is 64% which is encouraging. VBAC should only be offered after careful selection of patients at places with all facilities of Operation Theater and blood banks.