Evaluation of Trials of Labor After Previous Cesarean Section in Ain Shams University Maternity Hospital

Ain Shams University368 enrolled

Overview

The purpose of the study to evaluate the practice and short term maternal and perinatal outcomes of trial of labor after cesarean section offered to women at Ain Shams University Maternity Hospital (ASUMH) during the 3-year period from January 2013 to December 2015.

This is a retrospective study that was performed at Ain Shams University Maternity Hospital. The following data will be gathered (whenever available), tabulated and subjected to the proper statistical analysis: History: * Age * Duration of marriage * Inter-pregnancy interval * Gestational age (by menstrual dates or US) * Obstetric history (parity, mode of delivery, assisted vaginal delivery, previous vaginal birth after cesarean section, neonatal outcome) * Present and past history of any medical, surgical or obstetric problems; history of infection after previous CS General examination: * General condition * Vital data Abdominal examination: * Fundal level * Estimated fetal weight (clinically or by US) * Scar tenderness Vaginal examination on admission: * Cervical status * Station of presenting part * Membranes status * Pelvic adequacy Investigations performed: * Complete Blood Count * Ultrasonography Intrapartum management: * Progress and duration of labor according to partogram (or admission-delivery time) * Intrapartum complications; placental abruption, uterine rupture, hysterectomy, complications during surgical intervention if any Mode of delivery: * Vaginal delivery (spontaneous, assisted, complications) * Cesarean section (indication, scar dehiscence) Postpartum Data: * Postpartum hemorrhage * Blood transfusion * Neonatal outcome; fetal weight, birth trauma, Neonatal Intensive Care Unit admission, mortality

Study Type

OBSERVATIONAL

Enrollment

368

Conditions

Vaginal Birth After Cesarean

Eligibility

Sex: FEMALEMin age: 20 YearsMax age: 35 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Women admitted in labour * One prior caesarean section * Singleton pregnancy * Vertex-presenting fetus Exclusion Criteria: * Prior high-risk uterine scar; uterine rupture, classical CS, hysterotomy or myomectomy * Short inter-delivery interval (\<12 months) * Complications in the previous CS (e.g. puerperal sepsis) * Obstetric indication for CS (either elective or emergency): * Placenta praevia * Placental abruption * Documented evidence of cephalopelvic disproportion * Fetal macrosomia (estimated fetal weight \>4 kg) * Fetal anomalies interfering with vaginal delivery e.g. hydrocephalus * Fetal distress or non-reassuring Cardiotocography pattern

Outcomes

Primary Outcomes

Number of Participants With Successful Vaginal Birth

Mode of delivery: either successful vaginal birth after cesarean section or failed trial of labor (ending in emergency intrapartum cesarean section).

Time frame: 24 hours after onset of trial of labor

Secondary Outcomes

Number of Participants Who Had Maternal Morbidity

• Maternal morbidity: * Uterine rupture * Surgical injuries (during emergency CS) * Hemorrhage and blood transfusion * Peripartum hysterectomy

Time frame: 48 hours after onset of trial of labor

Adverse Perinatal Outcomes

• Adverse perinatal outcomes: * Apgar score * Neonatal Intensive Care Unit admission * Respiratory morbidity, e.g. transient tachypnoea of the newborn * Hypoxic ischaemic encephalopathy * Birth trauma * Mortality

Time frame: 48 hours postpartum

Data from ClinicalTrials.gov

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