Vol 43 # 3 September 2011 - Kma.org.kw

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Re-appraisal of Vaginal Delivery after Previous Two Cesarean Sections
September 2011
of CS. It is recommended that every woman who is
planning a birth after two previous CS, is encouraged
and supported to plan a vaginal birth in a hospital
setting.
CONCLUSION
The findings of this study are similar to those of
previous studies suggesting that a trial of vaginal
delivery after prior two CS is a reasonable option in
women in whom it is not obstetrically contraindicated
and who are appropriately counseled and managed.
The high success rate of vaginal deliveries (95%)
achieved in this study group could be attributed to its
selective nature. However, the sample size may be too
small to draw any firm conclusions. Therefore, larger
trials would need to be undertaken in our community
to support the results achieved.
As much as possible, women with previous two CS
should be involved in the decision-making regarding
the mode of their delivery to reduce the rise in repeat CS
rate. Unless something is done about the rise in the CS
rate, our obstetrics’ future may end in peril of repeated
CS. It is advisable therefore, that every obstetric unit
should have ongoing CS reduction initiatives, with
emphasis laid on the importance of careful selection
of such women.
ACKNOWLEDGMENT
I am grateful to Ms Najma Khalil for her assistance
in statistics and would wish to thank Ms Denden
Ponsaran for her secretarial work. I would also like to
offer my sincere appreciation to Professor Babatunde
Adelusi for editorial advice.
REFERENCES
1. Obstetricians and Gynaecologists’ Clinical Effectiveness
Support Unit: National Sentinel Caesarean Section
Audit Report: London (UK): Royal College of
Obstetricians and Gynaecologists: 2001.
2. Khashoggi T, Sultan MH, Al-Nuaim L, Addar M,
Chowdhury N, Adelusi B. Primary CS in King Khalid
University Hospital: Indications and obstetric outcome.
Ann Saudi Med 1995; 15:585-588.
3. ACOG practice bulletins: Vaginal birth after previous
cesarean delivery. Int J Gynecol Obstet 1999; 66:197-
204.
4. Hamilton BE , Martin JA , Sutton PD. Births: preliminary
data for 2003. Natl Vital Stat Rep 2004; 53 (9).
5. Menacker F. Trends in cesarean rates for first births and
repeat cesarean rates for low risk women: United States,
1990-2003. Natl Vital Stat Rep 2005; 54:1-8.
6. Jakobi P, Weissman A, Paldi E. Reversing the upward
trend in the caesarian section rate. Eur J Obstet Gynecol
Reprod Biol 1987; 25:105.
7. Shiono PH, McNellis D, Rhoads GC. Reasons for the
rising cesarean delivery rates: 1978 - 1984. Obstet
Gynecol 1987; 69:696 - 700.
8. Sultan MH, Al-Nuaim L, Khashoggi T, Chowdhury N,
Kangave D, Adelusi B. Sequelae of repeat caesarean
sections. Int J Gynecol Obstet 1996; 52:126-132.
9. Gillian M, Rosenberg D, Davis F. The likelihood of
placenta previa with greater number of caesarean
deliveries and higher parity. Obstet Gynecol 2002;
99:976-980.
10 Kastner E, Figueroa R, Garry D. Emergency peripartum
hysterectomy: Experience in a community teaching
hospital. Obstet Gynecol 2002; 99:971-975.
11. Paul RH, Phelan JP, Yeh S. Trial of labor in patients
with a prior cesarean birth. Am J Obstet Gynecol 1985;
151:297-304.
12. Gibbs CE. Planned vaginal delivery following caesarean
section. Clin Obstet Gynecol 1980; 23:507-515.
13. Flamm BL, Lim OW, Jones C, Fallon D, Newman
LA, Mantis JK. Vaginal birth after CS: Results of a
multicentre study. Am J Obstet Gynecol 1988; 158:1079-
1084.
14. Weinstein D, Benshushan Y, Ezra N, Rojonsky. Vaginal
birth after CS: Current opinion. Int J Gynecol Obstet
1996; 53: 1-10.
15. Coltart TM, Davies JA, Katesmark M. Outcome of
second pregnancy after a previous CS. Br J Obstet
Gynaecol 1990; 97:1140-1143.
16. Muylder X DE, Thiery M. The cesarean delivery rate
can be safely reduced in a developing country. Obstet
Gynecol 1990; 75:360-364.
17. McMahon M, Luther E, Bowes W, et al. Comparison of a
trial of labor with an elective second caesarean section.
N Eng J Med 1996; 335:689-695.
18. Flamm BL, Newman L, Thomas S, et al. Vaginal birth
after caesarean delivery; Results of a 5 year multicentre
collaborative study. Obstet Gynaecol 1990; 76:750-754.
19. Porreco RP, Meier PR. Trial of labour in patients
with multiple previous caesarean sections. J Reprod
Medicine 1983; 28:770-772.
20. Farmakides G, Duvivien R, Schulman H, Schneider E,
Biordi J. Vaginal birth after two or more previous CS.
Am J Obstet Gynecol 1987; 156:565-566.
21. Phelan JP, Ahn MO, Diaz F, Brar HS, Rodriguez MH.
Twice a caesarean section, always a cesarean? Obstet
Gynecol 1989; 73: 161-165.
22. Jeannes N, Stephens A, Myer DO, Gleicher N. Obstetric
outcome of patients with more than one prior CS. Am J
Obstet Gynecol 1989; 16:364-367.
23. Chattopadhyay SK, Sherbeeni MM, Anokute CC.
Planned vaginal delivery after previous caesarean
section. Br J Obstet Gynecol 1994; 101:498-500.
24. Bretelle F, Cravello L, Shojai R, Roger V, D’Ercole C,
Blanc B. Vaginal birth following two previous caesarean
sections. Eur J Obstet Gynecol Reprod Biol 2001; 94:23-
26.
25. Spaans WA , van der Vliet LME, Roell -Schorer EAM,
Bleker OP, van Roosmalen J. Trial of labor after two or
three previous CS. Eur J Obstet Gynecol Reprod Biol
2003; 110:16-19.
26. Landon MB, Spong CY , Thom E, Hauth JC , Bloom
SL, Varner MW. Risk of uterine rupture with a trial of
labor in women with multiple and single prior cesarean
delivery. Obstet Gynecol 2006; 108:12-20.
27. Cragin EB. Conservatism in Obstetrics. NY Med J 1916;
104:1-3.