A COMPARATIVE STUDY ON MATERNAL AND NEONATAL OUTCOMES IN VAGINAL BIRTH AFTER CAESAREAN SECTION VERSUS ELECTIVE LOWER SEGMENT CAESAREAN SECTION
Main Article Content
Keywords
Abstract
Background: The increasing rate of caesarean sections in India has raised concern over unnecessary repeat surgeries. Vaginal Birth After Caesarean (VBAC) offers a potential alternative with fewer maternal risks and improved neonatal bonding.
Materials and Methods: A prospective observational study was conducted over 18 months at our tertiary care hospital. A total of 200 women with a history of one prior lower segment caesarean section and term singleton pregnancies were enrolled. They were grouped into VBAC (n=100) and Elective Lower Segment Caesarean Section (ELSCS, n=100) based on delivery mode. Results: VBAC was successful in 78% of cases. Maternal complications such as febrile morbidity and hospital stay were significantly lower in the VBAC group. Neonatal outcomes were comparable between groups, with earlier initiation of breastfeeding observed in the VBAC group. Uterine rupture occurred in 1% of VBAC cases, with no maternal deaths.
Conclusion: VBAC is a viable and safe alternative to ELSCS when proper case selection and intrapartum monitoring are ensured. Promoting VBAC in India could reduce caesarean-related morbidity and healthcare costs.
References
2. Betrán AP, Ye J, Moller A-B, Zhang J, Gülmezoglu AM, Torloni MR. The increasing trend in caesarean section rates: global, regional and national estimates. PLOS ONE. 2016;11(2):e0148343.
3. Guise J-M, McDonagh MS, Osterweil P, Nygren P, Chan BK, Helfand M. Systematic review of the incidence and consequences of uterine rupture in women with previous cesarean section. BMJ. 2004;329(7456):19–25.
4. Landon MB, Hauth JC, Leveno KJ, Spong CY, Leindecker S, Varner MW, et al. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. N Engl J Med. 2004;351(25):2581–9.
5. ACOG Practice Bulletin No. 205: Vaginal birth after cesarean delivery. Obstet Gynecol. 2019;133(2):e110–27.
6. Arulkumaran S, Gibb DM, Lun KC, Heng SH, Ratnam SS. Trial of labour after previous caesarean section. Aust N Z J Obstet Gynaecol. 1989;29(2):125–31.
7. Madaan M, Trivedi SS, Agrawal S. Vaginal birth after cesarean section: a 10-year experience. J Obstet Gynaecol India. 2010;60(6):498–502.
8. Patel RR, Peters TJ, Murphy DJ. Prenatal risk factors for Caesarean section. Acta Obstet Gynecol Scand. 2005;84(5):506–13.
9. Sentilhes L, Vayssière C, Beucher G, Deneux-Tharaux C, Deruelle P, Diemunsch P, et al. Delivery for women with a previous cesarean: guidelines for clinical practice from the French College of Gynecologists and Obstetricians. Eur J Obstet Gynecol Reprod Biol. 2013;170(1):25–32.
10. Lundgren I, van Limbeek E, Vehvilainen-Julkunen K, Nilsson C. Clinician-centred interventions to increase vaginal birth after cesarean section (VBAC): a systematic review. BMC Pregnancy Childbirth. 2015;15:16.
11. Tahseen S, Griffiths M. Vaginal birth after two caesarean sections (VBAC-2): a systematic review with meta-analysis of success rate and adverse outcomes of VBAC-2 versus VBAC-1 and repeat (third) cesarean deliveries. BJOG. 2010;117(1):5–19.
12. Aiken ARA, Aiken CE, Trussell J, Brockelsby J. Outcomes associated with first birth after cesarean delivery: a population-based study. BJOG. 2014;121(2):169–75.
13. Bujold E, Hammoud AO, Schild C, Krapp M, Baumann P. Trial of labor in patients with a previous cesarean section: does maternal age influence the outcome? Am J Obstet Gynecol. 2004;190(4):1113–8.
14. Eden KB, McDonagh M, Denman MA, Marshall N, Emeis C, Fu R, et al. New insights on vaginal birth after cesarean: can it be predicted? Obstet Gynecol. 2008;112(2 Pt 1):307–17.
15. Dodd JM, Crowther CA, Huertas E, Guise JM, Horey D. Planned elective repeat caesarean section versus planned vaginal birth for women with a previous caesarean birth. Cochrane Database Syst Rev. 2013;(12):CD004224.
16. Prior E, Santhakumaran S, Gale C, Philipps LH, Modi N, Hyde MJ. Breastfeeding after cesarean delivery: a systematic review and meta-analysis of world literature. Am J Clin Nutr. 2012;95(5):1113–35.
17. Fitzpatrick KE, Kurinczuk JJ, Alfirevic Z, Spark P, Brocklehurst P, Knight M. Uterine rupture by intended mode of delivery in the UK: a national case-control study. PLoS Med. 2012;9(3):e1001184.
18. Rossi AC, D’Addario V. Maternal morbidity following a trial of labor after cesarean section vs elective repeat cesarean delivery: a systematic review with meta-analysis. Am J Obstet Gynecol. 2008;199(3):224.e1–8.
19. Gandhi MN, Shah NB. Obstetricians’ perspective on VBAC: a cross-sectional study in Gujarat. J Obstet Gynaecol India. 2018;68(2):124–9.
20. Sinha M, Gupta R, Singh N. VBAC: do we need to revisit the guidelines? Int J Reprod Contracept Obstet Gynecol. 2017;6(3):1121–6.
21. Ministry of Health and Family Welfare. Operational Guidelines for Obstetric Services. Government of India; 2018.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr. Vartika Awasthi
Associate Professor, Dept. of OBG, Prasad Institute of Medical Sciences, Lucknow, UP
Dr. Abhilasha Parihar
Associate Professor, Dept. of OBG, Hind Institute of Medical Sciences, Lucknow, UP
Dr. Charu Pandey
Assistant Professor, Dept. of Pediatrics, Integral Institute of Medical Sciences and Research