A study on the outcome of a trial of labour after cesarean (TOLAC) with one previous caesarean delivery

Abstract

Background: The rate of primary cesarean section (CS) is on the rising trend. More and more women report to ANC OPD with a history of previous cesarean delivery. Vaginal birth after a caesarean section can be an effective alternative to a cesarean section and decrease the complications associated with a repeat caesarean. Objectives: This study aims to determine the acceptability and outcome of TOLAC in women with one previous cesarean delivery in a tertiary care centre. Methods: The prospective observational study was carried out in a tertiary care teaching hospital over a period of one year. Sixty pregnant women with a history of one previous LSCS were enrolled in the study. Results: In the present study, a total of 60 cases with previous LSCS were included. 78.33% of cases had a successful TOLAC i.e vaginal birth after cesarean (VBAC) and 21.67% underwent a repeat emergency LSCS for failed TOLAC. Cervical dilatation of 4 cm and more at the time of admission was a significant factor for successful TOLAC. Having a previous vaginal birth also had a favourable prognosis in achieving a VBAC (89%). A birth weight of more than 3,000 gm was associated with a lower success rate of TOLAC. The incidence of scar dehiscence was 1.6% in the present study. There was no maternal or neonatal mortality. Conclusion: TOLAC in selected cases has great importance in the present era because of the rising rate of primary CS. With continuous efforts and proper antenatal counselling, TOLAC can be attempted with very low complication rates. This will further decrease the untoward complications associated with a repeat cesarean.

Keywords

• tolac
• vbac
• cesarean delivery
• pregnancy