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Audit of vaginal birth after one caesarean: the experience of a medium-sized district general hospital
  1. A Vais,
  2. OE Oteri,
  3. D Sivasathiaseelan
  1. Lincoln County Hospital, Lincoln, UK

Abstract

Background and Objective Vaginal birth after Caesarean (VBAC) is recommended by the Royal College of Obstetricians and Gynaecologists after one Caesarean section (CS), assuming success rates of >70%. This figure is used to counsel women regarding mode of future delivery.

The authors conducted a retrospective audit of women with one previous CS who delivered at Lincoln County Hospital in 2009 to establish local success rates of VBAC to guide counselling our patients.

Results During 2009, 115 VBACs were attempted and 170 elective repeat Caesareans (ERCS) performed in women who had only had one previous CS; 47 of ERCS had other indications for Caesarean as well (eg, breech, placenta praevia, fetal macrosomia). Of 115 women who attempted VBAC, 53 had spontaneous vaginal deliveries (46%), 10 had an instrumental delivery (8.69%) and 52 were delivered by CS in labour (45.2%). The overall success rate of VBAC was 54.7%. However, this was 50% in women whose previous CS was their only delivery and 69% in women who had had vaginal deliveries as well as a previous CS.

Complications included two cases of suspected scar dehiscence (1.73%) and one scar rupture (0.86%).

Conclusion 48% of women eligible for VBAC chose this option. 75% of these were attempting VBAC as their second ever delivery. The rate of success for this group was found to be 50%, not 70% as suggested by guidelines. The authors feel that appropriate counselling of women regarding mode of delivery after one CS should include success rates accurate for their obstetric history and locally applicable statistics.

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