Vaginal caesarian section for emergency delivery, short and long term complications: a retrospective study over 15 years

Abstract

Vaginal Cesarean Section (VCS) is a little known surgicalobstetrical technique that is rarely practiced today. The main indication to perform a VCS remained an urgent fetal extraction early in the course of a pregnancy. In life-threatening situations where an emergency extraction of the fetus and the termination of the pregnancy is deemed necessary, and in very early pregnancies, this technique could be an interesting alternative to conventional Abdominal Cesarean Section (ASC) [1]. The theoretical advantage of VCS was to avoid a myometrial incision and to spare a maximum of myometrial muscular fibers. Furthermore, it was a simple et rapid procedure, with moderate peri operative bleeding and simple postoperative period [2]. The medical method, with premedication by mifepristone, 36-48 h before vaginal misoprostol administration and additional delivery induction interval, is a long procedure for emergency situations such as sepsis, total placenta praevia complicated by hemorrhage [1]. We conducted a retrospective study in the Obstetrical and Gynecologic Department at a single tertiary-care hospital (René Dubos Hospital) in Pontoise, France, between 01/01/2000 and 31/ 12/2014. Cases with VCS were identified from the birth registry, and demographic data were obtained from clinical records. All women who underwent VCS, had subsequently both gynecological and obstetrical follow up for subsequent pregnancies in our institution. VCS section was performed according to the modified Dü hrssen's incision [3] as described by Lacomme [4]. During the study period 26 women delivered by VCS. The major indication (42.3%) for VCS was an emergency termination of pregnancy for a life-threatening obstetrical complication, such as severe preeclampsia, eclampsia, HELLP syndrome, or chorioamniotitis associated with sepsis. In 34.7% of the cases, the indication was complete placenta praevia associated with severe hemorrhage, and in 23% the indication was labor induction failure for intrauterine fetal death or medical interruption for fetal reasons. The median gestational age was 23 weeks + 4 days