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Audit of management of women with one previous caesarean section at the Royal Infirmary of Edinburgh
  1. JS Elder,
  2. J Wilkens
  1. Simpsons Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, UK

Abstract

Introduction This audit assesses the management of women with one previous Caesarean section (CS) at the Royal Infirmary Edinburgh (RIE) compared to the Royal College of Obstetricians and Gynaecologists (RCOG) guideline ‘birth after previous Caesarean birth’1 and rate of vaginal births after Caesarean section (VBAC) compared to national rates.

Materials and Methods All women delivered at the RIE between 21 January 2009 and 6 May 2009 at term with one previous CS were eligible. A prospective case note analysis was carried out using a standardised questionnaire. Data were collected regarding antenatal care, labour and delivery.

Results 158 women were included. The overall VBAC rate was 42% and 71% in women with one previous vaginal delivery. 73% of women aiming for a VBAC were successful. 74% of CS were elective. Most common recorded indications were maternal request for elective CS (24%) and delay in first stage for emergency CS (41%). One case of uterine rupture occurred. Antenatal counselling was documented in 86% and carried out by a consultant in 61%. Most patients (98%) were managed on labour ward.

Conclusion The overall VBAC rate (42%) compared well with current national rates of 33%. The success rate in women intending a VBAC (73%) was as quoted by the RCOG (72–76%). Recommendations may be made to further encourage VBACs: (1) Improved documentation regarding counselling and indication for CS; (2) Patient information leaflet to be received at primary CS and booking; (3) Communication workshop for trainees counselling regarding VBAC.

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