Analysis of Patients with Previous One Scar and their Outcome in Term of Successful TOLAC
Objective: To see the fetal and maternal outcome in all those pregnant patients with previous one cesarean, to determine the safe mode of delivery for them and to make future recommendations especially aiming to reduce the rising cesarean section rate.
Methodology: This is a retrospective cohort observational study from 1st January 2014 till 31st December 2018. Especially designed proforma was filled for all the patients with previous one scar admitted in our department of Holy Family Hospital, Rawalpindi. Variables e.g. condition of the patient at admission, detailed obstetrical history, the decision about mode of delivery, intra and postpartum complications and outcome (maternal and fetal) were collected.
Results: A total of 49,790 patients delivered during five years. Out of which, 6106 (12.21%) patients have pervious one scar. Out of these 12.21% patients, 2441 (39.49%) patients were given a trial of labour after cesarean section. Successful VBAC occurred in 1972 (80%) of these patients and 469 (20%) had an emergency cesarean section. A total of 4122 (67.5%) patients were not given trial of scar and planned repeat cesarean section was decided for them. VBAC rate among all the patients with the previous one scar was 39.49 %. Successful TOLAC rate among those given trial was 80.7%. Adverse outcome (fetal death or uterine rupture) calculated to be very low (6/6107) that is 0.0024%.
Conclusion: Women with pervious cesarean sections comprise a high proportion of obstetrical admission. Trial of labour in selected patients in the obstetrical units of tertiary care hospitals is safe depending upon the available resources to monitor the labour along with emergency obstetrical theatre.
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