Comparative Analysis of Maternal and Perinatal Outcomes of Trial of Vaginal Birth and Planned Repeat Caesarean Section Following a Prior Caesarean

Abstract

Background: Delivery following a previous caesarean section is associated with the fear of increased maternal and perinatal morbidity and mortality. The optimal mode of such delivery remains critical with increasing rate of caesarean births in the contemporary obstetric care. The intended choice of mode of delivery for the woman and her clinician remains between trial of vaginal birth after caesarean and elective repeat caesarean section. This study was therefore designed to appraise the obstetric outcomes of the two main modes of delivery after a primary caesarean delivery. Objective: This study assessed the feto-maternal implications of trial of vaginal birth and elective caesarean section after a prior caesarean in order to contribute data to the increasing volume of evidence for expeditious management of increasing caesarean section rates. Specifically the maternal and perinatal outcomes of trial of vaginal birth after caesarean (TVBAC) and elective repeat caesarean delivery (ELRCD) were estimated and compared. Methodology: This was a comparative analytical observational study of 245 and 57 women who respectively had Trial of vaginal birth after caesarean (TVBAC) and elective repeat caesarean section (ELRCS) in their subsequent delivery following a primary caesarean section. EPI-INFO statistical package was used for data collation and analysis. Results: Trial of vaginal birth was associated with 1.22% risk of hysterectomy, 0.82% of uterine rupture and 1.6% long hospital stay unlike elective repeat caesarean section that had no recorded incidence of any of these morbidities. The women who had TVBAC were twice at increased risk of blood transfusion and more than 50% increased risk of postpartum hemorrhage compared to those who had ELRCS. The differences were however not statistically significant. Composite perinatal morbidity was thrice higher among TVBAC  (5.3% vs. 1.8%, OR 3.14 P=0.48) mainly 3.3%, 1.2% and 1.6% of Apgar scores less than7 at 5 minute, fresh stillbirths and perinatal deaths respectively. Again none of the differences was statistically significant. The morbidities associated with TVBAC seemed to increase when it failed and the need for emergency caesarean arose. Conclusion: There appeared to be subtle but insignificant increased likelihood of both maternal and perinatal adverse outcomes in trial of vaginal birth after caesarean. We recommend TVBAC in well selected cases since the feto-maternal outcome appeared similar in the two modes of delivery.