THE OUTCOME OF VAGINAL BIRTH AFTER ONE PREVIOUS CAESAREAN SECTION (VBAC) AT THE UNIVERSITY OF NIGERIA TEACHING HOSPITAL, ENUGU, SOUTH EAST NIGERIA

Abstract

Background: Reports from the developing countries on the safety and success rates of vaginal birth after one previous caesarean delivery are variable.8,24 Although the existing global caesarean section rates are high and rising, obstetricians are generally reluctant to conduct vaginal delivery in women with a previous caesarean section because of conceivable complications and concern for possible litigation.
Objectives: To determine the prevalence of patients, with one previous caesarean section at the UNTH. Also to determine and compare the maternal and fetal outcomes of labour in women who attempted VBAC successfully or not and those undergoing elective caesarean section.
Design: It was a prospective cross-sectional study of pregnant women with one previous caesarean section. It examined the outcome of pregnancy in such women following attempt at vaginal birth or an elective repeat caesarean section.
Setting: Department of Obstetrics and Gynaecology, UNTH Ituku – Ozalla, Enugu.
Subjects: Seventy one (71) consecutive pregnant women with one previous caesarean section who met the inclusion criteria were recruited.

Main Outcome Measures: The main outcome measures for each patient included the mode of delivery, fetal outcome (including Apgar scores, perinatal death and birth weight) and maternal outcome (including post partum haemorrhage, uterine rupture and maternal death).

Results: The prevalence of one previous caesarean section was found to be 13.6%. Sixty four (90.1%) of the women preferred to have vaginal delivery despite the one previous caesarean section while 7 (9.9%) opted for repeat elective caesarean section. Following assessment, 38 (53.5%) were recruited to have trial of VBAC by the obstetrician, out of whom 19 (50.0%) had successful VBAC. The fetal and maternal outcomes were generally good with no case of uterine rupture, perinatal or maternal mortality. Apgar scores of less than 7 in the first minute were significantly more frequent in those with successful VBAC compared with repeat elective caesarean section (P = 0.03) but there was no significant different with those with failed VBAC (P = 0.82). Birth weight of 4.0kg or greater was significantly more common in those with failed VBAC compared with successful VBAC (P = 0.03).
Conclusion: The findings of this study indicate that the maternal and fetal outcomes of labour in selected women with one previous caesarean delivery for non-recurrent indications are good, and comparable to those of women electively delivered by caesarean section.

THE OUTCOME OF VAGINAL BIRTH AFTER ONE PREVIOUS CAESAREAN SECTION (VBAC) AT THE UNIVERSITY OF NIGERIA TEACHING HOSPITAL, ENUGU, SOUTH EAST NIGERIA