Vaginal Birth After Cesarean
Conditions
Brief summary
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.
Detailed description
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
Interventions
None listed
Sponsors
Ain Shams University
Study design
Observational model
OTHER
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
FEMALE
Age
20 Years to 35 Years
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
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With Successful Vaginal Birth | 24 hours after onset of trial of labor | Mode of delivery: either successful vaginal birth after cesarean section or failed trial of labor (ending in emergency intrapartum cesarean section). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants Who Had Maternal Morbidity | 48 hours after onset of trial of labor | • Maternal morbidity: * Uterine rupture * Surgical injuries (during emergency CS) * Hemorrhage and blood transfusion * Peripartum hysterectomy |
| Adverse Perinatal Outcomes | 48 hours postpartum | • 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 |
Participant flow
Recruitment details
This is a retrospective study that was performed at Ain Shams University Maternity Hospital during the 3-year period from January 2013 to December 2015.
Participants by arm
| Arm | Count |
|---|---|
| Trial Of Labour After Caesarean Section The following data was gathered (whenever available), tabulated and subjected to the proper statistical analysis:
-Vaginal examination on admission: Cervical status Station of presenting part Membranes status Pelvic adequacy
-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 | 368 |
| Total | 368 |
Baseline characteristics
| Characteristic | Trial Of Labour After Caesarean Section |
|---|---|
| Age, Categorical <=18 years | 0 Participants |
| Age, Categorical >=65 years | 0 Participants |
| Age, Categorical Between 18 and 65 years | 368 Participants |
| Age, Continuous | 28.6 years STANDARD_DEVIATION 4.6 |
| Region of Enrollment Egypt | 368 Participants |
| Sex: Female, Male Female | 368 Participants |
| Sex: Female, Male Male | 0 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 0 / 368 |
| serious Total, serious adverse events | 0 / 368 |
Outcome results
Primary
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
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Trial Of Labour After Caesarean Section | Number of Participants With Successful Vaginal Birth | 317 Participants |
Secondary
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
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Trial Of Labour After Caesarean Section | Adverse Perinatal Outcomes | 332 Participants |
Secondary
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
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Trial Of Labour After Caesarean Section | Number of Participants Who Had Maternal Morbidity | 338 Participants |