Introduction The CS rate in Scotland has increased from 8.6% in 1976 to 25.4% in 2010 (AMH rate 28.6%).1 RCOG guidance on the subject of VBAC (vaginal birth after caesarean section) highlights the importance of informative antenatal counselling. The overall VBAC success is quoted at 72-76%.2
Method Using the Aberdeen Maternity and Neonatal Databank (AMND) we identified all women who delivered from 1993 – 2006 with singleton pregnancies and a history of one previous CS. We compared those who were planning a repeat CS with those planning a VBAC. Outcomes of interest included mode of delivery and factors thought to affect VBAC success (maternal age, BMI, gestation of delivery, induction of labour and gestation at induction).
Results We identified 2350 women, 61.1% of women had a successful VBAC. Woman < 20 yrs had a successful VBAC in 77.3% of cases compared to 57% in the >35yr age group. The chance of having a CS was higher if BMI was greater than 30 (46% compared to 34%). If labour occurred spontaneously 65.1% had a successful outcome. A lower rate of 51.1% was seen if labour was induced. The majority of women who were induced were at 41 weeks.
Discussion Overall the success of a planned VBAC in NHS Grampian is lower than the RCOG rate 2. Age and BMI do impact on success. Prolonging the 2nd stage of labour has reduced our local CS rate; it remains unclear whether it has had an impact on this planned VBAC group.
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