Vaginal birth after cesarean section (VBAC) versus emergency repeat cesarean section at teaching hospitals in India: an ICMR task force study

Background: Objective of current study was to study the outcome of trial of vaginal birth after Previous Cesarean Section (PCS) and indications for emergency repeat cesarean section at teaching hospitals in India. Methods: Prospective data was recorded on management practices, associated complications and mortality for a period of 8 months in 2005-2006 at 30 medical colleges/teaching hospitals for delivery. Results: A total of 155863 deliveries occurred during the study duration, there were 28.1% (n=43824) cesarean section and (10.1%) (n=15664) were the number of previous cesarean section. In 84% (n=13151) had repeat cesarean delivery and 2513 (16%) delivered vaginally. A trial of labor was planned in 4035 (25.8%) women. The success rate of VBAC was 62.3% with 2513 women had successful vaginal delivery and 1522 (37.7%) delivered by emergency repeat cesarean section. Major indication of emergency cesarean section was CPD (52.9%), foetal distress (25.8%), severe PIH/eclampsia (5.0%), previous 2 CS (0.7%), APH (1.4%) and others (2.7%). In majority, surgical technique was conventional and in 3.7% the Misgav-Ladach technique was used. Scar dehiscence and surgical complications were observed in 5.4% and 4.0% of cases respectively. Blood transfusion was given in 7.0% and post-operative complications were seen in 6.8%. Perinatal and maternal mortality was 18.0/1000 and 257/100000 deliveries respectively. Conclusions: Safety in childbirth for women with prior cesarean is a major public health concern. Repeat caesarean section and planned vaginal birth after cesarean section are both associated with benefits and harms and correct management represents one of the most significant and challenging issues in obstetric practice.