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|Title: ||Vaginal Birth after a Previous Caesarean Section: Current Trends and Outlook Ghana|
|Other Titles: ||L'accouchement Vaginal Apres Une Cesarienne Anterieure: Les Tendances Actuelles Et Les Perspectives Au Ghana|
|Authors: ||Seffah, J.D.|
|Issue Date: ||2014|
|Publisher: ||Journal of the West African College of Surgeons|
|Series/Report no.: ||Vol. 4;No.2; Pp1-25|
|Abstract: ||Background: The optimal mode of subsequent delivery of women with prior caesarean birth remains a subject of
intense research and debate in contemporary obstetric practice especially in low resource settings like West Africa
where there are obvious systemic and management-related challenges associated with trial of scar. However, there
is evidence that vaginal birth after caesarean section (VBAC) is safe in appropriately selected women in addition to
adequate intrapartum monitoring and ready access to theatre when emergency CS is indicated.
Aim &0bjectives:The primary objective of the study was to determine the current trends and performance of VBAC in
Ghana after decades of practice of trial of labour after caesarean section (TOLAC) in the mist of inherent challenges in
deciding the optimal mode of childbirth for women with a previous caesarean birth. The secondary objective was to
relate evidence based practice of TOLAC to obstetric practice in low resource settings like Ghana and provide
recommendations for improving maternal and newborn health among women with prior caesarean birth
Patients & Methods: This was a retrospective study of the records of patients who had had a prior caesarean
delivery and who then proceeded to deliver the next babies at the Korle Bu Teaching Hospital (KBTH) between Jan
2010 and Dec 2014. The data on demography, antenatal care, labour and delivery and outcomes were collected
from the Labour and Recovery wards and the Biostatistics unit of the Maternity unit of the Hospital. Excluded were
women with a previous CS who had multiple pregnancies and those with incomplete notes as well as those whose
delivery plans were not predetermined antenatally.. The data were analyzed using SPSS version 20.
Results: There were 53,581 deliveries during the study period. Vaginal delivery was obtained in 31,870 (59.5%)
pregnancies and 21,711(40.S%) had CS. Also, 6261 (11.7%) had had a prior CS and 2472 (39.5%) of these were
selected forTOl.AC while 2119 (33.8) were scheduled for planned repeat CS. There was an inverse trend between
the annual caesarean sections rates and the proportion of women with one previous CS scheduled for TOLAC.
There was a statistically significant difference between women who had successful or failed VBAC regarding
maternal age, parity, number of ANC visits, gestational age at delivery, birth weight, Apgar score at 1 min and Apgar
score at 5 min. Birth weights of less than 1.5kg, and 3.5kg or greater were associated significantly with higher
incidence failed TOLAC and emergency repeat CS. However, birth weights ranging from 2.0 to 3.49kg were
associated with significantly lower incidence of failed TOLAC and emergency repeat CS. Birth weight of 2.5»2.99kg
was associated with the lowest incidence of failed TOLAC and repeat CS.
Conclusion: There is a significantly high vaginal birth after caesarian section (VBAC) success rate among carefully
selected women undergoing trial of scar in Ghana although a decreasing trend towards trial of labor after caesarian
section (TOLAC) and a rising CS rate were determined. TOLAC remains a viable option for child birth in low resource
settings like West Africa even though there are specific clinical and management related challenges to overcome.
Adequate patient education and counselling in addition to appropriate patient selection for TOLAC remains the
cornerstone to achieving high VBAC success rate with minimal adverse outcomes in such settings.|
|Appears in Collections:||Surgery|
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