Journal of South Asian Federation of Obstetrics and Gynaecology

Register      Login

VOLUME 12 , ISSUE 4 ( July-August, 2020 ) > List of Articles

Original Article

Prediction of Vaginal Birth after Cesarean Section Using Scoring System at the Time of Admission for Trial of Labor: A One-year Prospective Cohort Study

Pooja Kiran, Mrityunjay C Metgud, Mallayya Kenchaveeraiah Swamy

Citation Information : Kiran P, Metgud MC, Swamy MK. Prediction of Vaginal Birth after Cesarean Section Using Scoring System at the Time of Admission for Trial of Labor: A One-year Prospective Cohort Study. J South Asian Feder Obs Gynae 2020; 12 (4):224-229.

DOI: 10.5005/jp-journals-10006-1809

License: CC BY-NC 4.0

Published Online: 28-09-2020

Copyright Statement:  Copyright © 2020; The Author(s).


Abstract

Aims and objectives: To assess the prediction of a successful trial of labor after cesarean section (TOLAC) using a predictive scoring system at the time of labor. Materials and methods: The present study was a prospective cohort study. Women with one previous lower segment cesarean section (LSCS) in labor admitted to the labor room, willing for a vaginal birth after cesarean section (VBAC) were included in the study and explained about the option of TOLAC with the predictive score (integer score) and its success. The predictive validity of the VBAC score was assessed by the receiver operating curve (ROC) analysis. Results: A total of 194 women were included in the study. The proportion of successful VBAC was 43.30% in the current study. The most common indication for previous LSCS in the patients who underwent repeat LSCS was nonprogress of labor (17.53%) followed by fetal distress in 12.89%. The VBAC score had good predictive validity in predicting successful VBAC, as indicated by the area under the curve of 0.853 (95% CI 0.798 to 0.908, p value < 0.001). The sensitivity of a VBAC score of 13.5 or more in predicting successful VBAC was 83.3% (95 CI 75.36% to 91.3%) and specificity was 78.2% (95 CI 70.46% to 85.9%). Positive predictive value was 74.5% (95 CI 65.65% to 83.3%), negative predictive value was 86% (95 CI 79.2% to 92.8%), and the total diagnostic accuracy was 80.4% (95 CI 74.83% to 86%). After controlling the effect of other values in the equation, the history of previous vaginal birth and high modified Bishop score were the factors that were significantly associated with successful VBAC. The symptomatic uterine rupture occurred in 0.1% of women who underwent TOLAC. No perinatal morbidity or mortality is seen. Conclusion: Vaginal birth after cesarean section score has demonstrated as a good predictive validity in predicting successful VBAC. TOLAC should be encouraged in most of the women who are willing to attempt it, provided no obstetric contraindication exists.


HTML PDF Share
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.