A Comparative Study of Fetomaternal Outcome of Elective Cesarean and Vaginal Birth after Cesarean Section in a Tertiary Care Center in South India
Sathya Prabha Jagannathan, Hingmire M Sunil, Prema Nalligounder
Cohort study, Elective repeat cesarean section, Maternal and neonatal outcome, Trial of labor after cesarean section
Citation Information :
Jagannathan SP, Sunil HM, Nalligounder P. A Comparative Study of Fetomaternal Outcome of Elective Cesarean and Vaginal Birth after Cesarean Section in a Tertiary Care Center in South India. J South Asian Feder Obs Gynae 2021; 13 (5):283-287.
Aims and objectives: To provide evidence-based information to choose the mode of delivery following a single cesarean section in a tertiary center in South India. The objective is to study the success rate, safety, and efficacy of vaginal birth after cesarean section (VBAC) by comparing the maternal and perinatal outcome with the elective repeat cesarean section (ERCS).
Materials and methods: This was a prospective, cohort study done over a period of 12 months in a tertiary care center. Based on the patients’ preference, a total of 211 women who satisfied the inclusion criteria were divided into two groups—either trial of labor after cesarean section (TOLAC) or ERCS group.
Results: Success rate of VBAC was found to be 47.9%. About 15% of failed VBAC was due to the tendency to abandon TOLAC midway. Although the maternal complications were found to be higher in TOLAC, p value (0.347) was not found to be significant. There was no increased risk of neonatal morbidity and mortality in the TOLAC group when compared to ERCS (p = 0.814). There was also no difference found in Apgar scores (<7) at 5 minutes and newborn intensive care unit (NICU) admissions in the TOLAC group and in the ERCS group (p = 0.899).
Conclusion: The success rate of VBAC was found to be 47.9%. There was no significant risk of maternal and perinatal complications compared to ERCS.
Clinical significance: Although VBAC was found to be successful in developed countries, we need more of studies in our Indian setup with the local population to improve the quality of health care and create awareness among patients. This present study might boost the obstetricians in the tertiary care setup to counsel more for TOLAC.
National Institutes of Health Consensus Development Conference Panel. National Institutes of Health Consensus Development conference statement: vaginal birth after cesarean: new insights March 8–10, 2010. Obstet Gynecol 2010;115(6):1279–1295. DOI: 10.1097/AOG.0b013e3181e459e5.
Hamilton B, Martin J, Ventura S. Births: preliminary data for 2009. National Statistics Reports. vol. 59. Hyattsville, MD: National Center for Health Statistics; 2010.
Zhang J, Troendle J, Reddy U, et al. Contemporary cesarean delivery practice in the United States. Am J Obstet Gynecol 2010;203(4):326.e1–326.e10. DOI: 10.1016/j.ajog.2010.06.058.
Sargent J, Caughey AB. Vaginal birth after cesarean trends: which way is the pendulum swinging? Obstet Gynecol Clin North Am 2017;44(4):655–666. DOI: 10.1016/j.ogc.2017.08.006.
ACOG Practice Bulletin No. 205: Vaginal Birth after Cesarean delivery. Obstet Gynecol 2019;133(2):e110–e127. DOI: 10.1097/AOG.0000000000003078.
Curtin SC, Gregory KD, Korst LM, et al. Maternal morbidity for vaginal and cesarean deliveries, according to previous cesarean history: new data from the birth certificate, 2013. Natl Vital Stat Rep 2015;64(4):1–13 [Level III]. PMID: 26046963.
Silver RM, Landon MB, Rouse DJ, et al. Maternal morbidity associated with multiple repeat cesarean deliveries. National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network. Obstet Gynecol 2006;107(6):1226–1232 [Level II-2]. DOI: 10.1097/01.AOG.0000219750.79480.84.
Ananth CV, Smulian JC, Vintzileos AM. The association of placenta previa with history of cesarean delivery and abortion: a meta-analysis. Am J Obstet Gynecol 1997;177(5):1071–1078 [Meta-Analysis]. DOI: 10.1016/s0002-9378(97)70017-6.
Cahill AG, Stamilio DM, Odibo AO, et al. Is vaginal birth after cesarean (VBAC) or elective repeat cesarean safer in women with a prior vaginal delivery? Am J Obstet Gynecol 2006;195(4):1143–1147 [Level II-2]. DOI: 10.1016/j.ajog.2006.06.045.
Grobman WA, Lai Y, Landon MB, et al. Can a prediction model for vaginal birth after cesarean also predict the probability of morbidity related to a trial of labor? Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network. Am J Obstet Gynecol 2009;200(1):56.e1–56.e6 [Level II-3]. DOI: 10.1016/j.ajog.2008.06.039.
Landon MB, Hauth JC, Leveno KJ, et al. National Institute of Child Health and Human Development Maternal Fetal Medicine Units Network. Maternal and perinatal outcomes associated with trial of labour after prior caesarean delivery. NEJM 2004;351(25):2581–2589. DOI: 10.1056/NEJMoa040405.
Stone C, Halliday J, Lumley J, et al. Vaginal birth after caesarean (VBAC): a population study. Paediatr Perinat Epidemiol 2000;14(4):340–348. DOI: 10.1046/j.1365-3016.2000.00299.x.
Boulvain M, Fraser WD, Brisson-Carroll G, et al. Trial of labour after caesarean section in sub-Saharan Africa: a meta-analysis. Br J Obstet Gynaecol 1997;104(12):1385–1390. DOI: 10.1111/j.1471-0528.1997.tb11008.x.
Fisler RE, Cohen AC, Ringer SA, et al. Neonatal outcome after trial of labor compared with elective repeat cesarean section. Birth 2003;30(2):83–88. DOI: 10.1046/j.1523-536x.2003.00225.x.
Guise J-M, Eden K, Emeis C, et al. Vaginal birth after cesarean: new insights. Evidence report/technology assessment no.191. (Prepared by the Oregon Health and Science University Evidence-based Practice Center under contract no. 290-2007-10057-I). AHRQ Publication No. 10-E003. Rockville (MD): Agency for Healthcare Research and Quality; 2010.
Kamath BD, Todd JK, Glazner JE, et al. Neonatal outcomes after elective cesarean delivery. Obstet Gynecol 2009;133(6):1231–1238. DOI: 10.1097/AOG.0b013e3181a66d57.
Flamm BL, Geiger AM. Vaginal birth after caesarean delivery: an admission scoring system. Obstet Gynecol 1997;90(6):907. DOI: 10.1016/s0029-7844(97)00531-0.