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2. Vaginal birth after cesarean section (VBAC) versus emergency repeat cesarean section at teaching hospitals in India: an ICMR task force study

Author

B. Dhillon, Nomita Chandhiok, Bharti S., Bhatia P., Coyaji K.J., Das M.C., Das V., Davar R.G., Devambigai S., Ganguly G., Ghosh T.K., Gopalan S., Habeebulah S., Idnani R., Kochar S., Kodkany B.S., Madhini V., Mittal S., Mukherjee J., Naphade P.R., Nevrekar P., Padmanaban I., Pagi S.L., Patnaik S., Rajarajeswari S., Salhan S., Salvi V., Sanghamitra M., Sharma S., Soni I.J.K., Sulekha P.B., and Taly A.

Subjects
Gynecology, medicine.medical_specialty, Eclampsia, Blood transfusion, Repeat Cesarean Section, business.industry, Vaginal birth, Vaginal delivery, medicine.medical_treatment, Public health, medicine.disease, Childbirth, Medicine, Caesarean section, business, reproductive and urinary physiology
Abstract

Background: Objective of current study was to study the outcome of trial of vaginal birth after Previous Cesarean Section (PCS) and indications for emergency repeat cesarean section at teaching hospitals in India. Methods: Prospective data was recorded on management practices, associated complications and mortality for a period of 8 months in 2005-2006 at 30 medical colleges/teaching hospitals for delivery. Results: A total of 155863 deliveries occurred during the study duration, there were 28.1% (n=43824) cesarean section and (10.1%) (n=15664) were the number of previous cesarean section. In 84% (n=13151) had repeat cesarean delivery and 2513 (16%) delivered vaginally. A trial of labor was planned in 4035 (25.8%) women. The success rate of VBAC was 62.3% with 2513 women had successful vaginal delivery and 1522 (37.7%) delivered by emergency repeat cesarean section. Major indication of emergency cesarean section was CPD (52.9%), foetal distress (25.8%), severe PIH/eclampsia (5.0%), previous 2 CS (0.7%), APH (1.4%) and others (2.7%). In majority, surgical technique was conventional and in 3.7% the Misgav-Ladach technique was used. Scar dehiscence and surgical complications were observed in 5.4% and 4.0% of cases respectively. Blood transfusion was given in 7.0% and post-operative complications were seen in 6.8%. Perinatal and maternal mortality was 18.0/1000 and 257/100000 deliveries respectively. Conclusions: Safety in childbirth for women with prior cesarean is a major public health concern. Repeat caesarean section and planned vaginal birth after cesarean section are both associated with benefits and harms and correct management represents one of the most significant and challenging issues in obstetric practice.

Published
2014
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3. Too far, too little, too late: a community-based case-control study of maternal mortality in rural west Maharashtra, India(*)

Author

Ganatra, B.R., Coyaji, K.J., and Rao, V.N.

Subjects
India -- Health aspects, Patient outcomes, Health aspects, Maternal mortality -- Health aspects, Mortality, Pregnancy complications -- Patient outcomes, Mothers -- Patient outcomes, Pregnancy, Complications of -- Patient outcomes
Abstract

Introduction The launch of the global Safe Motherhood Initiative (SMI) in Nairobi in 1987 and the subsequent World Summit for Children in 1990 brought into focus the hitherto 'neglected tragedy' [...], A total of 121 maternal deaths, identified through multiple-source surveillance in 400 villages in Maharashtra, were prospectively enrolled during 1993-95 in a population-based case-control study, which compared deaths with the survivors of similar pregnancy complications. The cases took significantly longer to seek care and to make the first health contact after the decision to seek care was taken. They also travelled significantly greater distances through a greater number of health facilities before appropriate treatment was started. Multivariate analysis showed the negative effect of excessive referrals and the protective effect of the following: residing in and not away from the village; presence of a resident nurse in the village; having an educated husband and a trained attendant at delivery; and being at the woman's parents' home at the time of illness. Other significant findings showed that deaths due to domestic violence were the second-largest cause of deaths in pregnancy, that more than two-thirds of maternal deaths were underreported in official records, and that liveborn infants of maternal deaths had a markedly higher risk of dying in the first year of life. This study points to the need for information--education--communication (IEC) efforts to increase family (especially male) preparedness for emergencies, decentralized obstetric management with effective triage, and a restructuring of the referral system.

Published
1998

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