Benefits, risks of vaginal birth, caesarean section.
Dubai -- The number of pregnant women with a previous cesarean section (C.S) are increasing due to the ever-increasing rate of cesarean section worldwide.
These women should visit a specialist obstetrician to discuss the options of delivery before 36 weeks gestationso that they become aware of the risks and benefits of both vaginal birth andelective/planned cesarean explainsDr Tasneem Husaini Rangwala, Specialist Gynaecologist, Zulekha Hospital,Dubai.
Women who are suitable for vaginal birth:
Those who had one uncomplicated lower segment cesarean section and have an otherwise uncomplicated pregnancyand go into spontaneous labour.
The success rate is 70--75 per cent, if she never had vaginal delivery, but 85- 90 per cent if she had a vaginal delivery before or after her caesarean.
Success rate for vaginal delivery is also good for women who had cesarean for fetal reasons.
Success rate is also good for women with previous cesarean who go into preterm labour. The risk of uterine rupture is lowered. Women not suitable for vaginal birth are those withprevious uterine rupture, previous classical cesarean (vertical scar in uterus) or having three or more previous cesareans.
Risk factors for unsuccessful vaginal delivery:
Induction of labour, advanced maternal age, BMI > 30, no previous vaginal birth, more than 41 weeks gestation, previous cesarean done for dystocia (failure of dilatation of cervix or head descent), pregnancy interval from previous cesarean is less than two years.
Further discussion with a consultantobstetrician is needed when the womanwith one previous cesarean has a complicated current pregnancy or there were difficulties at previous cesarean, she has had two previous cesareans or the woman requires induction of labour.
Risk of vaginal birth after caesarean include:
0.5 per cent risk of uterine rupture in spont labour, 2 -- 3 times increased risk if labour is induced this could be seriousfor both mother and baby.
1 per cent risk of hemorrhage requiringblood transfusion.
Benefits of vaginal birth include:
Reduced risk of respiratory problems in neonate -- transient tachyphoea, Respiratory Distress Syndrome. It is 2--3 per cent with vaginal birth and 3--4 per cent with elective cesarean.
Quicker return to normal activities like driving, lifting, shorter stay in hospital.
Avoids further cesarean and hence risks associated with multiple cesareans, like placenta previa, accreta, adhesions between organs, trauma to bowel/bladder and need for caesarean hysterectomy.
Management during labour
Women should deliver in a hospital which is equipped with specialists. IV line should be in place after admission.
Continuous monitoring for baby's heart beat. Epidural analgesia can be given pulse and BP should bechecked hourly and monitoring for signs of uterine rupture like abnormal
CTG, acute scar pain, blood staine durine, abnormal bleeding, maternal shock.
If a woman with previous cesarean needs induction -- the decision to induce and method used should be made by a consultant obstetrician as there is 2--3 times increased risk of scar rupture. Prostaglandins are not licensed for use in previous cesareancases. Cervical ripening balloon is an alternative to prostaglandins which is associated with lesser risk of uterine rupture, but that is also not licensed for use in induction.
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