Publication: Outcome of labour of untested caesarean scar and factors affecting its outcome in Sabah Women and Child Health Hospital
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Date
2020
Authors
Luong, Charlie Wong Choong
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Abstract
Objective: Caesarean section rate is on a rising trend worldwide resulting in increased pregnancies with previous caesarean scar. Proper patient selection for trial of labour after caesarean section is important as this improve success rate as well as reduce morbidity associated with labour. It is known that the single important predictor value is history of successful VBAC. Therefore. this study aims to evaluate the success rate of VBAC as well as to explore the factors affecting its success rate after excluding patient with history of successful VBAC. Methods: A retrospective cohort study was conducted at Hospital Wanita dan Kanak Kanak Sabah (HWKKS) involving reviews of patients’ record with one previous lower segment caesarean section which is untested and going for trial of labour in the hospital. The information obtained includes sociodemographic distribution, maternal non-modifiable and modifiable factors, antenatal and intrapartum factors and outcome of the delivery. The data were analysed using SPSS by multiple logistic regression. Results: The success rate of untested VBAC was 66.8%. The significant factors affecting the success rate of VBAC include inter-delivery intervals more than 60 months (adjusted OR 2.128, 95% CI 1.343 – 3.373), maternal obesity (adjusted OR 1.457 1.303 – 1.629), absence of previous vaginal birth (adjusted OR 3.436, 95%CI 2.307 – 5.118), increasing estimated fetal weight (adjusted OR 2.723, 95%CI 1.385 – 5.354), induction of labour (adjusted OR 3.645, 95% CI 2.541 – 5.227) and previous caesarean section for the indication of malpresentation, placenta previa, poor progress of labour, prolonged second stage of labour and cord prolapse. Following an unsuccessful VBAC, the risk of PPH is statistically insignificant. The OASIS risk increases with the need for instrumental delivery. The risk of uterine scar dehiscence increases with short inter-delivery interval. Their neonatal risk of neonatal asphyxia and meconium aspiration syndrome is considerably low. Conclusions: Proper patient selection can reduce morbidity associated with trial of labour after caesarean section as well as avoid unnecessary morbidity associated with repeated caesarean section. Obstetrician should assist the patient in making a sound decision on her delivery plan
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