A STUDY OF THE OUTCOME OF SUBSEQUENT PREGNANCY FOLLOWING PREVIOUS CESAREAN SECTION

CORRESPONDING AUTHOR:
Dr. Suman Poddar,
Rama Apartment (2nd Floor),
19, Lal Baba Road, PO+PS: Dankuni,
Dist. Hooghly, West Bengal,
India, PIN – 712311.
E-mail: drsuman81@yahoo.in

BACKGROUND: With the world-wide rising trend of caesarean delivery (CD), modern obstetric practice deals with a new group of mothers carrying reproductive performance upon a scarred uterus with obvious risk in feto-maternal outcome.  AIMS: (1) To analyse the maternal & neonatal outcome in post-caesarean pregnancy. (2) To evaluate the factors influencing outcome in such cases. Design: Observational analytical study. MATERIALS & METHODS: The present study was carried out over two years (2010-11) taking consecutive 100 post-caesarean cases as admitted on my admission days & delivered in BR Singh Hospital. Data collection was done by interview technique along with hospital records. ANALYSIS USED: Percentage analysis was most often done. Categorical variables were compared with chi-square test; P value was calculated with 2012 Graphpad Software. Relative risk (RR) & Odd ratio (OR) were calculated with 1993-2012 Medcalc Software bvba (Version 12.3.0). All statistical tests were evaluated at the 0.05 significance level. RESULTS: Post-caesarean pregnancy rate was 26.02%. Vaginal birth after caesarean (VBAC) incidence was 22% whereas VBAC success on trial of labour was 55%. VBAC gave best morbidity outcome (18.18% & 27.27%). But failed VBAC cases result more significant maternal morbidity (RR=3.97, P=0.0037) & NICU admission was also found highest in failed VBAC cases (38.89%). Maternal and neonatal morbidity were significantly high when scar integrity was lost; also significantly co-related with elderly mothers (>35 yrs.), un-booked cases & non-admitted cases undergone repeat CD. CONCLUSIONS: Post-caesarean cases need meticulous antenatal check-up & mandatory institutional delivery with proper selection of mode of confinement to have a better maternal & neonatal outcome. 

KEYWORDS: Post-caesarean pregnancy, Vaginal birth after caesarean (VBAC), NICU admission, Maternal morbidity, failed VBAC