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Trial of labor in women with two previous caesarian sections: a challenge

  • Ima Indirayani ,
  • Hilwah Nora ,
  • Rusnaidi ,
  • Cut Meurah Yenni ,
  • Fatimah Zahara ,
  • Dara Meutia Ayu Febrina ,

Abstract

Introduction: A trial of labor after a cesarean (TOLAC) section is an option for mothers who have had a previous caesarian section. However, for those with two previous scars, there are pros and cons to allowing the patient to have a vaginal birth after a caesarian section (VBAC) because of increasing complications. The incidence of CS in Indonesia has been growing over the past year. In addition, several studies have shown an increased risk of problems in subsequent pregnancies in mothers with a history of cesarean section. Thus, VBAC in two previous scars becomes an alternative choice for a certain patient.

Case Illustration: We reported three cases of TOLAC; Three of which had been planned for vaginal birth after caesarian section (VBAC) since the prenatal period Case 1: A 30-year-old woman, G3P2, is 39 weeks pregnant and has had two previous cesarean sections. Cardiotocography was normal. The patient was closely monitoring the signs of uterine rupture during labor, and after 7 hours, she had a successful VBAC without complication. A female baby weighting 4000g was born, both mother and child were in good health condition. Case 2: A 38-year-old woman, G6P4A1, is 41 weeks pregnant has had two previous vaginal deliveries, and has had two previous caesarian section prior to this pregnancy. The patient was closely monitored for vital signs and signs of uterine rupture. Cardiotocography is normal. She had a successful VBAC without complications after eight hours and delivered a male baby with a body weight of 3500g and good APGAR CSore. Case 3: A 35-year-old woman, G3P2A0, had two previous CS admitted at 39 in the latent phase of labor with a cervical dilatation of 2 cm. The labor progressed to the second stage after nine hours. After an hour attempted to conduct delivery, the fetus was still not delivered. Catheterization was performed, which revealed hematuria and proceeded with emergency caesarian section due to suspect a uterine rupture. Intraoperatively, the uterine rupture was noted at the lower anterior of the uterine corpus, measuring 2x1 cm and a repair was performed.

Conclusion: VBAC can be considered in patients two previous c-sections with after proper selection, close monitoring and adequate counseling. Prenatal care is a concern for pregnant women to prevent complications and reduce maternal and fetal morbidity and mortality. The VBAC decision returned to personalization and adequate assessment and counseling are mandatory.

References

  1. ACOG Practice Bulletin No. 205: Vaginal Birth After Cesarean Delivery. Obstet & Gynecol. 2019;133(2):e110–27. Available from: http://dx.doi.org/10.1097/aog.0000000000003078
  2. Iglesias-Benavides JL, Cedeño-Morales VM, Guerrero-González G, Guzmán-López A. Labor trials in 300 patients with a previous cesarean section. Med Univ. 2017; Available from: http://dx.doi.org/10.1016/j.rmu.2017.10.005
  3. Varma R. The current management of vaginal birth after previous caesarean delivery. Obstet & Gynaecol. 2007;9(3):209a – 210. Available from: http://dx.doi.org/10.1576/toag.9.3.209a.27344
  4. Keedle H, Schmied V, Burns E, Dahlen HG. A narrative analysis of women’s experiences of planning a vaginal birth after caesarean (VBAC) in Australia using critical feminist theory. BMC Pregnancy Childbirth. 2019;19(1):142. Available from: https://pubmed.ncbi.nlm.nih.gov/31035957
  5. Ogonowski J, Miazgowski T. Intergenerational transmission of macrosomia in women with gestational diabetes and normal glucose tolerance. Eur J Obstet & Gynecol Reprod Biol. 2015;195:113–6. Available from: http://dx.doi.org/10.1016/j.ejogrb.2015.10.002
  6. Lundgren I, Morano S, Nilsson C, Sinclair M, Begley C. Cultural perspectives on vaginal birth after previous caesarean section in countries with high and low rates — A hermeneutic study. Women and Birth. 2020;33(4):e339–47. Available from: http://dx.doi.org/10.1016/j.wombi.2019.07.300
  7. Lurie S, Shalev A, Sadan O, Golan A. The changing indications and rates of cesarean section in one academic center over a 16-year period (1997–2012). Taiwan J Obstet Gynecol. 2016;55(4):499–502. Available from: http://dx.doi.org/10.1016/j.tjog.2014.12.014
  8. Mone F, Harrity C, Toner B, McNally A, Adams B, Currie A. Predicting why women have elective repeat cesarean deliveries and predictors of successful vaginal birth after cesarean. Int J Gynecol & Obstet. 2014;126(1):67–9. Available from: http://dx.doi.org/10.1016/j.ijgo.2013.12.013
  9. You S-H, Chang Y-L, Yen C-F. Rupture of the scarred and unscarred gravid uterus: Outcomes and risk factors analysis. Taiwan J Obstet Gynecol. 2018;57(2):248–54. Available from: http://dx.doi.org/10.1016/j.tjog.2018.02.014
  10. Elsaeed UA, Riad RI, Taher A, Elnokeety M, Elanwary S. Pregnancy outcomes in pregnant women with diabetes treated with insulin alone and insulin with metformin. Bali Medical Journal. 2022;11(3):1234–1242. https://doi.org/10.15562/bmj.v11i3.3082

How to Cite

Indirayani, I., Nora, H. ., Rusnaidi, Yenni, C. M. ., Zahara, F. ., & Febrina, D. M. A. . (2022). Trial of labor in women with two previous caesarian sections: a challenge. Bali Medical Journal, 12(1), 87–90. https://doi.org/10.15562/bmj.v12i1.3943

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