TITLE:
Vaginal Birth after a Cesarean Section at Good Shepherd Mission Hospital at Tshikaji in Democratic Republic of the Congo (DRC)
AUTHORS:
Mubikayi Mubalamate Leon, Yamba Kasanda Aristide, Mubikayi Kanku Yannick
KEYWORDS:
Lower Segment Cesarean Section, Scar Dehiscence, Trial of Labor, Vaginal Birth after Cesarean Section, Tshikaji Hospital
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.13 No.5,
May
26,
2023
ABSTRACT: Background: The success rate of vaginal birth after cesarean section with a single
cesarean scar is greater than 50%, the lack of the information about the safety
of vaginal birth after cesarean delivery pushes most of obstetricians to
increase the num ber of
cesarean sections following a previous cesarean section. Guidelines for Vaginal
birth after cesarean (VBAC)
indicate that TOLAC offers women with no contraindications and one previous
transverse low-segment cesarean. The objective of the current study was to
study the outcome of trial of labour after caesarean section (TOLAC), the
indications for emergency repeat cesarean section and to determine the maternal
and fetal prognosis in vaginal birth after caesarian section (VBAC) at Tshikaji
Mission Hospital. Patients, Material and Methods: This is a
retrospective study of the records of 126 women were selected to undergo the
TOLAC in the department of gynecology and obstetrics at the Tshikaji Mission Hospital
over the period from January 1st to December 31st, 2021.
The data on demography, antenatal care, labour and delivery and outcomes were
collected from the maternity unit of this hospital. The data were analyzed
using SPSS version 2.0. Results: The TOLAC in 126 studied women. The
course of work allowed vaginal delivery 107 parturient women, a success rate of
successful VBAC of 85% after the TOLAC. The repeat emergency cesarean section was
necessary for delivery in 15% of cases for failed TOLAC. There was no maternal
mortality, but we recorded one fetal death or 0.8% of perinatal mortality, 2
cases of cicatricial dehiscence, the incidence of 1.6%. Maternal morbidity
after delivery on cicatricial uterus was dominated by postpartum hemorrhages,
with 19 cases or 15.1% of
cases. Cervical dilatation of more than 3 cm at the time of admission, the
parity more than 3 and were the significant factors in favor of a successful
VBAC. Birth weight of more than 3500 g, fetal distress and malpresentation were
associated with a lower success rate of VBAC. The TOLAC in selected cases has
great importance in the present era of the rising rate of primary CS especially
in rural areas. Conclusion: Pregnancy on a cicatricial uterus represents
a high-risk pregnancy. Trial of VBAC in selected cases has great importance in
the present era of the rising rate of primary CS especially in rural areas.
There is a significantly high vaginal birth after caesarian section (VBAC)
success rate among selected women undergoing trial of scar in Tshikaji Hospital.
TOLAC remains the option for childbirth in low resource settings as Kasai
region in DRC. Adequate patient education and counselling in addition to
appropriate patient selection for TOLAC remain the cornerstone to achieving
high VBAC success rate.