الفهرس 
AbstractOnly 14 pages are availabe for public view
 |  | from | 92 |  |  |
| | | from | 92 | | |
Abstract
The trend of increasing CS rates had evoked worldwide attention. Many approaches were introduced to diminish cesarean section rates. Vaginal birth after cesarean section (VBAC) is a route of delivery with diverse agreements.
Repeated CS is related to serious maternal and fetal complications when compared to normal birth and the first cesarean.
Abnormal placenta development following repeated CS is concurrent with an increased risk of placenta previa and abruptio placenta in addition to placenta accreta.
The risk of placenta previa has been reported to increase by 0.28-2% in patients who have undergone at least 1 CS in a metaanalysis including 36 studies.
According to the World Health Organization (WHO) statement, the international healthcare community has considered the ideal rate for CSS to be between 10% and 15%.
According to the WHO recommendation, CSs should be performed only when medically necessary. Unfortunately, this recommendation fails to reverse the increasing trend of CS rates. Among the group of cesarean deliveries, repeated CS due to prior ones account for a remarkable proportion.
Several national medical associations have provided practice guidelines for VBAC. However, the evidence is inconsistent and the effect on VBAC rates is unclear.
The percentage of women trying VBAC varies due to multiple factors, but the service provider’s choice seems to be the most determinant factor.
Basically, the individuals’ variation comes from the ongoing debate about VBAC. Uncertainty about the rates of successful VBAC is one of the major concerns for both caregivers and pregnant women.
Individual factors, including the indication of prior CS, a history of prior vaginal birth, maternal factors, and the current pregnant status, affect the success rates. Many studies were conducted to investigate the predicting factors and rates of successful VBAC.
This retrospective descriptive study was conducted at department of obstetrics and gynecology – Beni Suef General Hospital for assessment of the incidence, maternal and neonatal outcomes of vaginal birth after cesarean section that was conducted between the 1st of January 2016 till 31st December 2017.
After approval of Beni-Suef General Hospital to conduct the research, the researcher obtained written permission from the manager of the hospital to conduct the study. The collected data included reported history taking, clinical examinations, preoperative and postoperative investigations, details of previous deliveries and maternal and fetal outcomes of vaginal delivery after cesarean section. In the current study, the total number of deliveries was 13768 (5265 “38.24%” women delivered by cesarean sections and 8503 “61.76%” delivered by vaginal deliveries). A total of 258 cases underwent TOLAC, the success rate of TOLAC was (84.9%) while the failure rate was (15.1%). The rate of successful VBAC was 1.6% from the total deliveries in 2016 and 2017.
Our study reported that, failed TOLAC was due to lack of labor progress in 32 and fetal distress in 7 cases.
Regarding demographic data, women with failed TOLAC in our study were of extreme age groups (less than 20 and more than 35) and from rural areas.
In our study, succeeded cases had a statistically significant history of previous vaginal deliveries, on the opposite hand; failed cases had a statistically significant history of more than 2 previous cesarean sections, higher proportion of elective section and lower duration between the last previous cesarean section and current pregnancy.
In our study, failed cases suffered from medical disorders with pregnancy as preeclampsia and had a multiple pregnancy, breach presentation, fetal macrosomia, prolonged latent phase of cervical dilatation and more utilization of oxytocin with statistically significant differences compared with succeeded cases.
Regarding maternal and fetal complications in our study, failed cases had statistically significant higher proportion of postpartum hemorrhage, uterine rupture and need to NICU admission and lower fetal heart rate and Apgar scores at 1st and 5th minutes.
The strengths of current study were due to incomplete files were excluded from data, every effort was made to ascertain that all data were documented, and only complete information was included in data analysis and assessment of study outcomes were done by the same researcher.
The limitations were due to the included data in our study related to pregnant cases who delivered during only two years and in a single general hospital .
In conclusion, compared with having another CS , a successful VBAC involved no surgery, none of the possible complications of surgery, a shorter hospital stay and a quicker return to normal daily activities. In addition, VBAC is an important option to avoid the risks of multiple CSs, such as placental problems.