Evaluation of Trials of Labor After Previous Cesarean Section in Ain Shams University Maternity Hospital

Completed

Brief Summary: The purpose of the study to evaluate the practice and short term maternal and perinatal outcomes of trial of labor after cesarean section offered to women at Ain Shams University Maternity Hospital (ASUMH) during the 3-year period from January 2013 to December 2015.

Detailed Description: This is a retrospective study that was performed at Ain Shams University Maternity Hospital.

The following data will be gathered (whenever available), tabulated and subjected to the proper statistical analysis:

History:

* Age

* Duration of marriage

* Inter-pregnancy interval

* Gestational age (by menstrual dates or US)

* Obstetric history (parity, mode of delivery, assisted vaginal delivery, previous vaginal birth after cesarean section, neonatal outcome)

* Present and past history of any medical, surgical or obstetric problems; history of infection after previous CS

General examination:

* General condition

* Vital data

Abdominal examination:

* Fundal level

* Estimated fetal weight (clinically or by US)

* Scar tenderness

Vaginal examination on admission:

* Cervical status

* Station of presenting part

* Membranes status

* Pelvic adequacy

Investigations performed:

* Complete Blood Count

* Ultrasonography

Intrapartum management:

* Progress and duration of labor according to partogram (or admission-delivery time)

* Intrapartum complications; placental abruption, uterine rupture, hysterectomy, complications during surgical intervention if any

Mode of delivery:

* Vaginal delivery (spontaneous, assisted, complications)

* Cesarean section (indication, scar dehiscence)

Postpartum Data:

* Postpartum hemorrhage

* Blood transfusion

* Neonatal outcome; fetal weight, birth trauma, Neonatal Intensive Care Unit admission, mortality

Recruitment & Eligibility

Inclusion Criteria

Exclusion Criteria

Prior high-risk uterine scar; uterine rupture, classical CS, hysterotomy or myomectomy
Short inter-delivery interval (<12 months)
Complications in the previous CS (e.g. puerperal sepsis)
Obstetric indication for CS (either elective or emergency):
- Placenta praevia
- Placental abruption
- Documented evidence of cephalopelvic disproportion
- Fetal macrosomia (estimated fetal weight >4 kg)
- Fetal anomalies interfering with vaginal delivery e.g. hydrocephalus
- Fetal distress or non-reassuring Cardiotocography pattern

Primary Outcome Measures

Name	Time	Method
Number of Participants With Successful Vaginal Birth	24 hours after onset of trial of labor	Mode of delivery: either successful vaginal birth after cesarean section or failed trial of labor (ending in emergency intrapartum cesarean section).

Secondary Outcome Measures

Name	Time	Method
Number of Participants Who Had Maternal Morbidity	48 hours after onset of trial of labor	• Maternal morbidity: * Uterine rupture * Surgical injuries (during emergency CS) * Hemorrhage and blood transfusion * Peripartum hysterectomy
Adverse Perinatal Outcomes	48 hours postpartum	• Adverse perinatal outcomes: * Apgar score * Neonatal Intensive Care Unit admission * Respiratory morbidity, e.g. transient tachypnoea of the newborn * Hypoxic ischaemic encephalopathy * Birth trauma * Mortality