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Background: To compare maternal and perinatal outcomes in trial of labor after cesarean (TOLAC) and Emergency repeat cesarean delivery (ERCD).Methods: Prospective observational study at tertiary care center for one year. Selection of candidates for Vaginal Birth after caesarean section (VBAC) was based on the 2010 American College of Obstetricians and Gynecologists’ (ACOG) recommendation. The maternal outcome was observed in the form of VBAC success rate, maternal complications, number of days in a hospital stay, The perinatal outcome was observed as 5 minute Apgar score and need for neonatal intensive care unit (NICU) admission.Results: 250 patients were given trial for vaginal delivery. VBAC success rate was 169/249 (67.9%). 80/249(32.1%) patients required repeat CS. Cases with Bishop score >6 had more rate of vaginal delivery (89.6%) as compared to Bishop score ≤6 (17.4%) (p=

Background: In a well-equipped hospital, trial of vaginal delivery is done in selected cases of previous C-section (CS). Epidural analgesia administration has been proved to be good adjunct in trial of labor after caesarean (TOLAC).Methods: This study is a prospective observational study done in a tertiary care institution in Tamil Nadu from May 2019 to July 2019. 50 cases with previous history of one CS were selected. Single ton pregnancy, previous transverse lower segment cesarean section admitted cases with adequate pelvis with no other co-morbidities were selected. Epidural analgesia was administered once mother was in established labor. TOLAC was continued till satisfactory progress and emergency repeat caesarean was taken in case of Suspected scar dehiscence (SSD) or abnormal fetal heart rate tracings. Quantitative data was expressed in mean and standard deviation. For qualitative data percentage was used.Results: In 50 cases observed the mean age of the cases was 26±3.64 years. TOLAC was successful in 41 (82%) mothers out of 50. The mode of delivery in 41 TOLAC mothers was found to be forceps in 18 cases (36%) and ventouse delivery 18 cases (36%). Only 9 cases had needed emergency CS (18%). The major indication for CS in TOLAC was found to be fetal distress in 4 number of cases (8%). 43 babies delivered were healthy, 6 babies (12%) admitted in NICU.Conclusions: With the application of epidural analgesia on attempted vaginal delivery in previous cesarean, vaginal delivery was 82% cases.

Background: Over the time the caesarean delivery rate has significantly increase worldwide from 18.2% in 2002 to 30.3% in 2012. In parous women, previous caesarean section has been found to be the most common indication for caesarean delivery in as high as 67% cases. Unsecure prediction of the integrity of the scarred LUS during labor appears to be one of the reasons for high repeat caesarean rates. The purpose of this study was to assess the usefulness of sonographic measurement of the lower uterine segment scar before labour for deciding whether it is a reliable safeguard for trial of labour or not in a woman having previous one caesarean delivery.Methods: This study was a prospective observational study, carried out on 108 pregnant women having previous one CS, gestational age >37, singleton pregnancy, cephalic presentation. Trans-abdominal USG was done to measure scar thickness. Trial of labour was given to each patient irrespective of scar thickness. Pregnancy outcome were noted in terms of successful VBAC or emergency LSCS and compared with scar thickness. Correlation between sonographic and intra-operative finding of scar were noted.Results: Result shows strong correlation between scar thickness and successful trial of labour. Scar thickness increases chances of successful vaginal deliveries.Conclusions: Sonographic assessment of previous scar has a practical application to predict the thickness and thinness of previous scar and can be taken as a reliable safeguard for trial of labour after previous cesarean but cut off value above which vaginal delivery could be considered safe is yet to be identified.

Background: Cesarean deliveries have been on the rise in recent decades, and as a result the question of how to manage subsequent deliveries becomes ever more important. The National Institute for Health and Care Excellence, RCOG, American College of Obstetricians and Gynecologists, and National Institutes of Health are in consensus that planned VBAC is a clinically safe choice for the majority of women with a single previous lower segment caesarean delivery, the authors explain. Aim of the study was to identify potential predictors of successful VBAC and study the risk and benefits involved. Methods: This was a prospective study in GCS Medical College. Seventy five cases were chosen fulfilling the eligibility criteria and were subjected to study. Results: The outcome was measured as successful VBAC. Out of 75 cases included in our study, 43 cases (57.3% of total cases) qualified for TOLAC during labour. Successful TOL (trial of labor) was observed in 48.8 % (21 out of 43) resulting in VBAC (vaginal birth after caesarean) and the rest 51.2% of failed TOL ended in repeat caesarean delivery. Conclusions: In our study, most of the women with successful VBAC were less than 30 years of age (95.2%). In our study, successful VBAC cases (90.5% of cases) presented with cervical dilatation more than equal to 4 cm and most cases (95.2%) of VBAC delivered before 38 weeks of gestation. Out of all VBAC’s, 62% (13 out of 21) had ante natal indication for their previous caesarean delivery; most common indication being breech. In our study, Repeat C.S. in failed TOL was performed for scar dehiscence in 41% cases.

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.

Background: Caesarean section has become increasingly the common method of delivery. From 1980 to 2001 the rate in UK has increased from 9% to 21% of all births. The aim of the study was to find out the outcome of delivery in women with previous cesarean section, the mode of delivery, maternal and fetal outcome of labour and various factors which influence the mode of delivery. Methods: 150 women with one previous caesarean section who attended the antenatal clinic and fit the inclusion criteria were enrolled in the study. Results: Success rate of VBAC was 30.5% among those included in trial of labour after caesarean section (TOLAC). 60.7% of the enrolled women underwent elective repeat caesarean section of which 54.9% were at the patients’ request. Favorable Bishop’s score (p= 0.0002) and previous cesarean section for breech (p=0.191) are positively associated with VBAC. Incidence of maternal complications in the study was 10.67% and 2.5% babies had an Apgar

Background: Globally, high rates of caesarean section (CS) are an issue of public health concern. For women who have had a previous caesarean, choices for mode of birth in their next pregnancy are either a trial of vaginal birth after caesarean (TOLAC) or an elective repeat caesarean delivery (ERCD). Both ERCD and TOLAC have benefits and risks associated.Methods: A prospective comparative study was conducted in the Department of Obstetrics and Gynecology at SDM college of medical science and hospital, Dharwad, Karnataka, India. The study included 80 women with one previous lower segment caesarean section over a period of 1 year. A 40 women underwent TOLAC and 40 women had a repeat caesarean section. The maternal and fetal outcomes in trial of labour after caesarean delivery and repeat caesarean delivery were compared.Results: In this study maternal morbidity was more common in ERCD group than in the TOLAC group. Neonatal outcome was the same in both the study groups. Conclusions: In our study the TOLAC success rate was 70-80%, pregnant woman with one previous lower segment Caesarean section should be given the option of TOLAC, unless contraindicated.

Background: The study was performed to assess the maternal and fetal outcome in post caesarean pregnancy as well as the various indications of a repeat caesarean section, so that, a definite protocol can be designed for selection of patient who is fit to undergo trial of labour after a previous caesarean section. This can reduce the rate of repeat caesarean section. Methods: This prospective observational study was carried out in the Department of Obstetrics and Gynaecology at Acharya Vinoba Bhave Rural Hospital, Sawangi, Wardha, India from August 2010 to July 2012. Results: During this period, a total 100 study cases with previous caesarean section were studied, of which 51 cases were selected for trial of vaginal delivery. 51 study cases were given trial of labour out of which 31 delivered vaginally. VBAC success rate at our institution during our study period was 60.78%. Out of total 69 cases who underwent caesarean section, maximum study cases presented with fetal distress 17(24.64%). Total 37 study cases were delivered by emergency caesarean section, maximum 17(45.94%) had indication of fetal distress followed by scar tenderness in 7(18.91%) cases. Conclusion: Substantial reduction in the caesarean rate can be achieved safely and efficiently by encouraging the trial of labour in women with a single previous caesarean delivery. Caesarean section should not be always followed by repeat caesarean section but patients must have hospital delivery in well equipped hospital and complications should be diagnosed at an early stage so that we can prevent maternal/ perinatal mortality and morbidity.

Background: The incidence of caesarean section is on the rise and has increased 2-3 folds from the initial rate of 10% during the last decade. The objective of the present study was to compare maternal outcomes in successful and failed trial of labour in women with previous one LSCS.Methods: This prospective observational study was carried out in Department of obstetrics & Gynaecology, Sanjay Gandhi memorial Hospital, New Delhi during 2015-2016 and included 150 gravid women with previous LSCS. The study was undertaken during March 2015 to May 2016. The ethical committee approval for the study has been taken.Results: out of 150 patients who had given a trial of labour, 64.7% (97) underwent successful VBAC and 35.3 %( 53) underwent emergency repeat LSCS. Majority of cases 59.3% were in age group 6.Conclusions: This study reveals that successful VBAC rate was 64.7% and 35.3% emergency repeat caesarean section.

Background: Caesarean section is one of the commonly performed surgical procedures in obstetrics and is certainly one of the oldest operations in surgery. One of the most dramatic features of modern obstetrics is the increase in the caesarean section rate. The present study was conducted to estimate proportion of various indications of LSCS and also to assess socio demographic profile of mothers undergoing caesarean section in a tertiary care centre. Methods: The present cross sectional observational study was conducted at Government Medical College & Hospital, Akola in the post natal ward (PNC). Non probability convenient sampling method was used. All patients admitted to PNC ward after LSCS were included in study. For data collection paper based pre tested, semi –structured questionnaire was used. Results: Previous LSCS was indication for LSCS in 32% cases. Eclampsia, preeclampsia and Anaemia were the indications for LSCS in 19.3%, 8.6% and 5.3% cases respectively. Other common indications includes CPD, meconium stained liquor, fetal distress, breech presentations, twin pregnancy and preterm labour. Conclusions: The proportion of LSCS is more than WHO recommended proportion of LSCS. It may be due to present institute acts as tertiary care center. Still this proportion is high, so encouragement should be given to trial of labour in selected low risk cases and in Primi patients whenever possible.

Background: Aim of study was to evaluate sonographically the scar thickness in pregnant women with previous one cesarean and study obstetric and perinatal outcome after trial of labour based on scar thickness.Methods: 50 pregnant women of gestational age >37 weeks were included in this prospective study. They were subjected to transabdominal ultrasound to search for thinnest zone of lower segment. Cases with scar thickness Results: 32 women had scar thickness ≥3.5 mm (mean = 3.99 ± 0.32). 18 women had scar thickness of Conclusions: Sonographic evaluation of scar thickness is safe and accurate procedure and is recommended in considering a trial of labour after previous one caesarean.

Background: The present study is an attempt to evaluate the efficacy of trans abdominal sonography to measure the thickness of scarred lower uterine segment at term and to detect anatomical defect if there is any to predict the risk of scar rupture. Methods: This study assessed the usefulness of sonographic measurement of lower uterine segment thickness in 100 patients with previous Caesarean patients. Lower uterine segment thickness was compared by antenatal sonography caliper measurements and observations during caesarean section. Results: Lower uterine segment thickness measured by ultrasonography correlated well with the thickness measured by vernier calipers at Caesarean section. Sensitivity of 92.86%, specificity of 77.27%, positive predictive value of 83.87% and negative predictive value of 89.47% suggested that if the thickness of lower uterine segment was 2.6 mm or more, chances of vaginal delivery following trial of labour was high. Conclusions: Antenatal ultrasonographic assessment of lower uterine segment thickness can result a successful trial of labour in women with previous caesarean section.