Evaluation of Trials of Labor After Previous Cesarean Section in Ain Shams University Maternity Hospital

This is a retrospective study that was performed at Ain Shams University Maternity Hospital.

The following data will be gathered (whenever available), tabulated and subjected to the proper statistical analysis:

History:

• Age
• Duration of marriage
• Inter-pregnancy interval
• Gestational age (by menstrual dates or US)
• Obstetric history (parity, mode of delivery, assisted vaginal delivery, previous vaginal birth after cesarean section, neonatal outcome)
• Present and past history of any medical, surgical or obstetric problems; history of infection after previous CS

General examination:

• General condition
• Vital data

Abdominal examination:

• Fundal level
• Estimated fetal weight (clinically or by US)
• Scar tenderness

Vaginal examination on admission:

• Cervical status
• Station of presenting part
• Membranes status
• Pelvic adequacy

Investigations performed:

• Complete Blood Count
• Ultrasonography

Intrapartum management:

• Progress and duration of labor according to partogram (or admission-delivery time)
• Intrapartum complications; placental abruption, uterine rupture, hysterectomy, complications during surgical intervention if any

Mode of delivery:

• Vaginal delivery (spontaneous, assisted, complications)
• Cesarean section (indication, scar dehiscence)

Postpartum Data:

• Postpartum hemorrhage
• Blood transfusion
• Neonatal outcome; fetal weight, birth trauma, Neonatal Intensive Care Unit admission, mortality

Inclusion criteria

• Women admitted in labour
• One prior caesarean section
• Singleton pregnancy
• Vertex-presenting fetus

Exclusion criteria

• Prior high-risk uterine scar; uterine rupture, classical CS, hysterotomy or myomectomy
• Short inter-delivery interval (<12 months)
• Complications in the previous CS (e.g. puerperal sepsis)
• Obstetric indication for CS (either elective or emergency):

• Placenta praevia
• Placental abruption
• Documented evidence of cephalopelvic disproportion
• Fetal macrosomia (estimated fetal weight >4 kg)
• Fetal anomalies interfering with vaginal delivery e.g. hydrocephalus
• Fetal distress or non-reassuring Cardiotocography pattern