Prediction Of Vaginal Birth After Caesarean Section Using Scoring System At The Time Of Admission For Trial Of Labour- A One Year Prospective Cohort Study

Abstract

ABSTRACT Objective To assess prediction of successful trial of labor after primary caesarean delivery (TOLAC) by using a predictive scoring system at the time of labour. Methods A one year prospective cohort study was conducted in a Dr Prabhakar Kore teaching hospital attached to Jawaharlal Nehru Medical College Belagavi during the period of January 2016 to December 2016. Total of 960 women who underwent one primary caesarean section in the past were screened for the study. Among these 413 women were eligible for the study and 194 were willing to participate and recruited for the study and data was obtained by counseling them regarding TOLAC, its risks and benefits by using predictive scoring system at the time admission to labour in each one of them individually. Multivariable, stepwise logistic regression was utilized and analysed. P value < 0.05 was considered statistically significant. IBM SPSS version 22 was used for statistical analysis. Results Vaginal delivery attempted by 194 women, the rate of successful VBAC among these women was 43.29%, 56.70% ended in repeat caesarean delivery. A VBAC score was generated based on modified Bishop score (cervical examination) at the time of admission, with points added for previous history of vaginal birth, age younger than <35years, absence of recurrent indication, and pre- pregnancy BMI <30. Women with a VBAC score more than 11 had a TOLAC success rate >60%. Majority of the women who had a previous breech indicated section underwent success of TOLAC by 67.44%. Symptomatic uterine rupture occurred in 0.1% women who underwent TOLAC. No perinatal morbidity or mortality is seen. Conclusion A trial of labour after one prior caesarean delivery should be encouraged in most of the women who are willing to attempt it, provided no obstetric contraindication exists. This study has generated a clinically useful scoring system for prediction of TOLAC success at the time of admission for the pregnancy after a primary cesarean delivery. Scoring system helps in prediction of successful VBAC. This information is relevant for counseling women about their choices after caesarean section.