The analysis of factors affecting the successful vaginal delivery after previous caesarean section

Aim: The purpose of this study was to analyse the factors that have influence on successful vaginal delivery after previous caesarean section (CS). Objectives: To determine the effect of birth weight on successful vaginal delivery after previous CS. To compare neonatal outcome in terms of Apgar score between vaginal delivery and urgent repeat CS groups. To evaluate the influence of labour induction, epidural analgesia and prior indication on the success of vaginal delivery after previous CS. Methods: We performed a retrospective study at the Department of Obstetrics and Gynaecology LUHS hospital over the period of one year from September 2014 to September 2015. The data were collected from medical cases of women who had already had one previous CS. In this period, 198 women had a successful vaginal delivery and 70 women had an urgent repeat CS. We have selected those, who had a successful vaginal delivery (I group, n=70) and those, who had an urgent repeat CS (II group, n=70). Results: The majority of women matched the recommendations of normal body mass index and gestational weight gain. In I group, 18 (25,7 %) women had a vaginal delivery before CS, in II group – 9 (12,9 %). 14 (20 %) women in I group had a vaginal delivery after previous CS and in II group there were no women with a vaginal delivery after CS. A statistically significant difference of overall duration of delivery between groups was not found (p=0,119). A statistically significant difference of neonatal outcome in terms of Apgar score at 1 and 5 minute between groups was not found (p=0,109, p=0,094). Neonates with weight of ≥4000 g were more likely to be born by CS (p=0,022). 36 (51,4 %) labours in II group had induction, in I group – 43 (61,4 %) (p=0,064). In II group the cervix was significantly less likely to be assessed as ready for the delivery (p=0,002). Epidural analgesia was applied for 29 (41,4 %) women in I group and for 28 (40,0 %) in II group (p=0,863). Previous indication as dystocia was more frequent in II group (p=0,046). For 30 (42,9 %) women both CS operations were performed for the identic indication: for 28 (93,3 %) women because of dystocia. Conclusions: Birth weight has a significant influence on delivery after previous CS, neonates with weight of ≥4000 g were more likely to be born by CS (p=0,022). Neonatal outcome in terms of Apgar score was similar among the infants whose mothers had a vaginal delivery and those whose mothers underwent urgent CS (p>0,05). Induction and epidural analgesia do not have any influence on successful vaginal delivery after previous CS (p>0,05). Previous indication of CS had an influence on successful vaginal delivery. Indication of CS was significantly related with previous indication of CS (p=0,013). For women, who underwent previous CS because of dystocia, this labour most often (84.8%) was completed in the operation for dystocia too