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Safety and efficacy of trial of labour after cesarean

Arihant Tater, Swati Garg, Ashmita Jawa, Monika Jain.

Abstract
Background: In recent years, there are increasing numbers of cases which report for delivery after previous LSCS. Trial of labour after lower segment cesarean section can save them from repeat LSCS and its complications. Aim of study was conducted to evaluate the safety and efficacy of trial of labour after LSCS.
Methods: This is a prospective study carried out at Mahatma Gandhi Hospital. One hundred pregnant patients with previous LSCS giving informed consent for trial of labour after cesarean section (TOLAC) were enrolled. Case selection was done as per the ACOG guidelines. Continuous fetal and maternal monitoring done by WHO partograph and cardiotocography. If there appeared any indication for repeat cesarean then emergency LSCS was done.
Results: In this study, 80% of the enrolled patients delivered vaginally and 20% underwent repeat emergency LSCS. 2% of the enrolled patients underwent scar dehiscence. The patients in the active phase of labour on admission had more chances of successful vaginal birth after cesarean section (VBAC). Birth weight of more than 3000 grams is associated with lower rates of successful VBAC. There was no maternal mortality but 1% intrauterine fetal death due to scar rupture was there.
Conclusions: TOLAC is safe and the success rates are good. Proper selection of cases with adequate fetal and maternal monitoring is required. So, once cesarean always cesarean is not a true dictum.

Key words: LSCS, Scars dehiscence, Trial of labour after cesarean section, Vaginal delivery after cesarean


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