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Caesarean Section
Published in Gowri Dorairajan, Management of Normal and High Risk Labour During Childbirth, 2022
There are many relative indications that are subject to variation, discussion, and sometimes criticism within the obstetric fraternity itself. A few of these are Precious pregnancy: All pregnancies are precious to the concerned woman, but sometimes conception in older women following artificial techniques (in vitro fertilisation/intracytoplasmic sperm injection/donor semen or ovum), previous multiple abortions, and adverse perinatal outcome add to the preciousness and may compel a caesarean section.Previous caesarean section: From simple refusal by the women, ineligibility, to lack of infrastructure for TOLAC can be taken as reasons for repeat scheduled caesarean sections.Diabetic ketoacidosis.PROM with failed induction.Frank chorioamnionitis.Impending renal shutdown in a woman with abruption. It is a rare indication and might have to be exercised even in the presence of intrauterine demise when the woman fails to respond to induction.
Operative delivery
Published in Louise C Kenny, Jenny E Myers, Obstetrics, 2017
Providing the first operation was carried out for a non-recurrent indication, and providing the obstetric situation close to term in the subsequent pregnancy is favourable, then it is appropriate to offer a trial of labour after caesarean (TOLAC) to any woman with a previous uncomplicated lower segment caesarean section and no other adverse obstetric feature. The predominant factors to be weighed when determining the recommended mode of delivery depend on the balance between the preferences of the mother, the risks of a repeat operation, the risks to her child of labour and the risk of labour on the integrity of the uterine scar.
Factors associated with the outcome of TOLAC after one previous caesarean section: a retrospective cohort study
Published in Journal of Obstetrics and Gynaecology, 2022
Shaina Parveen, Sasirekha Rengaraj, Latha Chaturvedula
A Caesarean Section is not always a safe option, especially in developing countries, as it increases the financial burden besides co-morbidities. The rise in primary Caesarean Section has led to a significant proportion of women with a previous Caesarean Section. One of the main areas of curtailing this rising Caesarean Section is offering VBAC to the women who have had a previous Caesarean Section. The maternal morbidity risk is decreased by VBAC compared with an elective repeat Caesarean Section (ERCS) (Birara and Gebrehiwot 2013; Grivell and Dodd 2014; Mercer et al. 2008). Trial of Labour after Caesarean (TOLAC) is the well-established standard of care in modern obstetrics. Obstetricians have been encouraged to offer vaginal delivery especially after one previous Caesarean Section in the past two decades. Vaginal delivery after one previous Caesarean Section for a non-recurring indication has been described by several authors as safe and as having a success rate of 60–80% (Mercer et al. 2008; Doshi et al. 2010; Birara and Gebrehiwot 2013).
The management of unusual uterine rupture: new aspects
Published in Journal of Obstetrics and Gynaecology, 2021
Milan Pavlović, Damir Zudenigo, Mario Kerner, Mislav Mikuš, Luka Matak
Uterine rupture is defined as full thickness separation of the uterine wall and overlying peritoneum, most commonly involving a previous uterine scar (Ofir et al. 2004). This unexpected life-threatening complication is exclusively associated with patients who attempt trial of labour after caesarean (TOLAC) and is related to the need for prompt surgical intervention. With the higher caesarean delivery rate, a sharply increasing trend of uterine rupture is expected (Betran et al. 2015). The risk of uterine rupture during TOLAC was reported as high as 0.9% in spontaneous labour, with two-fold greater risk in case of augmented or induced labour (Soltsman et al. 2018). This case presentation provides a supplement to overall knowledge about uterine rupture management with a new-modified uterine compression suture technique (Vujić et al. 2019).
Caesarean section rates: applying the modified ten-group Robson classification in an Australian tertiary hospital
Published in Journal of Obstetrics and Gynaecology, 2022
Leah Mayne, Cathy Liu, Keisuke Tanaka, Akwasi Amoako
An inherent limitation of the modified RTGCS is that women with previous CS attempting TOLAC and those presenting in spontaneous labour who proceed with an elective repeat CS are grouped together (Group 5a). By examining the CS indication, we were able to identify that the rate of successful vaginal birth in those presenting in spontaneous labour attempting TOLAC was 70.3%. This is similar to meta-analysis derived VBAC success rates of 72–75% (Guise et al. 2004, 2010). Given the likely high success rate of VBACs at our institution and the large number of women with previous CS, appropriately promoting TOLAC uptake is likely to significantly reduce our CS rates.