Current evidence in the management of previous caesarean section: clinical review

Abstract

The safety of women undergoing childbirth with prior caesarean delivery is a major public health concern. Most of the earlier studies focused on the success rate of vaginal birth after caesarean section; later focus shifted to maternal and neonatal safety, and presently, each factor that would influence the outcome of trial of labour is being considered on both the success and the safety of vaginal birth following caesarean delivery. The contribution of induction of labour to uterine rupture is not entirely clear. Although large multi-center randomised trials comparing planned elective repeat caesarean delivery vs vaginal delivery following prior caesarean delivery are required for conclusive evidence; current evidence suggests that, in properly selected women, vaginal birth can be safely achieved if adequate facilities to monitor the foetus and immediate caesarean can be performed. Unbiased evidence-based information should be given to patients in making decisions about mode of delivery based on individual characteristics. The purpose of this review is to understand each factor that would influence the success and safety of vaginal birth after caesarean delivery.

Late registration for antenatal care by pregnant women with previous history of caesarean section

“…34 In Thailand, factors influencing post-C/S morbidity included having less than four ANC visits and duration of labour longer than 12 h. 16 However, evidence suggests that vaginal birth can be safely achieved in women with previous C/S delivery. 31 In Scotland, 28% of 28 464 women who attempted vaginal delivery after a previous C/S delivery had an emergency C/S during labour. 32 Emergency C/S is associated with more fresh stillbirths, neonatal deaths, severe neonatal morbidity and increased maternal mortality compared with elective C/S delivery.…”

“…Patients with a previous history of C/S (even one) delivery, who attempt vaginal birth, are at risk of undergoing emergency C/S, rapture of uterus and losing their baby. 30 , 31 In Scotland women who had a planned vaginal birth after C/S were significantly more likely to have uterine rupture, blood transfusion, surgical injury, puerperal sepsis, perinatal deaths and perinatal admissions, compared with those who delivered by an elective C/S after a previous C/S delivery. 32 When vaginal birth after previous C/S was attempted, 28% – 55% of women ended up having an emergency C/S during labour.…”

“… 34 In Thailand, factors influencing post- C/S morbidity included having less than four ANC visits and duration of labour longer than 12 h. 16 However, evidence suggests that vaginal birth can be safely achieved in women with previous C/S delivery. 31 …”