^1,2Assistant Professor, Department of Obstetrics & Gynecology, Ashwini Rural Medical College, Hospital and Research Center, A/P - Kumbhari, Tal. South Solapur, Dist.- Solapur, Maharashtra, INDIA.

Email: mmpateltrust@gmail.com

RESULTS

Total 261 patients were given trial of labor. Out of those 193 patients (74%) delivered vaginally without assistance while only 5 patients (1.9%) required assistance with forceps. About 63 (24.2%) patients required repeat cesarean section.(fig 1)

Most of the patients 149(57.08%) were in age group 20-25 yrs followed by 25-30 yrs 78(29.88%). Only 28(10.72%) patients were above 30 yrs of age. The need for repeat cesarean section was more in 20-25 yrs age group 282% 42 (16.09%) followed by in 25-30 yrs 20(7.66%). Only 1 patient above 30 yrs of age required repeat C.S. There was highly significant rate of vaginal delivery in patients above 30 yrs of age. The patients were distributed with rising trend when associated with level of education. Most of the patients were having above school level of education. The need for repeat cesarean section was increasingly present in patients having higher education. Most of the patients were registered at study place. (75%) while patients who were admitted in emergency were only 17.24%. But need for repeat C. S. was more in registered patients in comparison with unregistered patients i.e.21.45% Vs 2.68%. Registration status and mode of delivery were significantly not associated(p>0.05) .(table2)  Lower uterine segment thickness was measured in 176 patients. lt could not be measured in 85 patients because most of them got admitted in active labor. lntraoperative finding of uterine dehiscence was present in only 2 patients these patients were not included in the study. Another important finding was that none of the patients with Lower uterine segment thickness <2.5 mm had uterine dehiscence.(table 3) When distributed according to gestational age most of the patients were in group 37 to 40 wks. About 55 patients were having gestation more than 40 weeks. More no. of patients required repeat C.S. as the gestational age went on increasing. Though this fact remained statistically insignificant when groups were compared among themselves. No. of the patients (n= 114) admitted in active phase of labor was slightly less than those admitted while not in active labor (n= 147). The need for repeat C.S was negligible in women having active labour at the time of admission to labor room i.e.2.68% when compared with another group i.e.21.45%. This association of failed trial with cervical dilatation was statistically extremely significant (table 4). When distributed according to gestational age most of the patients were in group 37 to 40 wks. About 55 patients were having gestation more than 40 weeks. More no. of patients required repeat C.S. as the gestational age went on increasing. Though this fact remained statistically insignificant when groups were compared among themselves.(table 5) Most of the patients who needed repeat C.S. were shifted because they developed fetal distress i.e.61% (n= 39) while 10 patients needed repeat C.S. because they failed to progress in labor accounting for 15.8%. Suspected dehiscence was indication in 8 patients while 6 patients had their latent phase of labor prolonged.(fig 2)

Figure 1: Mode of delivery

Figure 2: Distribution of patients according to indication for LSCS

DISCUSSION

The overall success rate of VBAC in our study was 74%. Various other study shows comparable results like Rageth et al. ⁴ 73.3%, Sims et al. ⁵ 77%, Elkousy et al. ⁶ 74% and Bujold et al. ⁷ 78 %. The success or failure, as in the cases of the present study, cannot be, thereby, attributed to the presence of a scar alone, but to the labour various maternal characteristics collectively, which precedes the repeat C.S. The repeat C.S. results due to failure of this labour. When distributed according to gestational age most of the patients were in group 37 to 40 wks. About 55 patients were having gestation more than 40 weeks. More no. of patients required repeat C.S. as the gestational age went on increasing. Though this fact remained statistically insignificant when groups were compared among themselves. Callahan et al., ⁸ in a case- control study, compared women attempting VBAC past 40 weeks of gestation with women of the same gestational age with no history of prior cesarean delivery. Among the cases, the VBAC success rate was similar to that reported in the literature (66%), but the choice of a comparison group without a history of prior cesarean limits the application of the study results to patient counseling. Zelop et al. ⁹ compared women attempting VBAC at or before 40 weeks of gestation with those attempting VBAC beyond 40 weeks. This study included 2,775 women, of whom 1,271delivered after 40 weeks. They found that women beyond 40 weeks were more likely to have a failed VBAC (35.4% compared with 26.7%, P < 0.001). ln the adjusted analysis, gestational age more than 40 weeks remained a risk factor for a failed VBAC both for spontaneous (OR 1.5, Cl 1.2 -1.8) and induced labor (OR 1.5, Cl 1.1-2.2). Hammond et al.¹⁰ reported their analysis of a cohort of patients attempting VBAC examined by gestational age category. They reviewed records of 329 patients 41 or more weeks of gestation attempting VBAC, comparing those with 2 groups of earlier gestational ages (24-36 6/7 weeks and37-40 6/7 weeks of gestation). They noted a lower rate of VBAC success with advanced gestational age. ln the present study, 147 patients reported in the latent phase and only 6.2 % delivered vaginally, while those who presented in active labor had successful VBAC in 93.8 % patients, a result comparable to findings those of Flamm and Geiger(1997) ¹¹ and Bujold(2004) ⁷ lt probably indicates, as early as in the latent phase, that the labor might not be a fruitful one. (table A)