Management of deliveries after caesarean section in Český Krumlov Hospital


Authors: MUDr. Lukáš Dostálek
Authors‘ workplace: prim. MUDr. Jan Shon Gynekologicko-porodnické oddělení, Nemocnice Český Krumlov
Published in: Prakt Gyn 2015; 19(1): 51-59
Category: Gynecology and Obstetrics: Review Article

Overview

Study type:
retrospective

Aim:
The aim of this study was to determine the success rate of births in patients with caesarean section in medical history in our clinic. We also wanted to determine the predictive factors for successful vaginal birth and the amount of risk which the vaginal birth after caesarean brings to the patient.

Metodics:
There were 1,060 births in our study, that took place in our clinic at the specified time. Out of this set there were 103 women, who had caesarean delivery in medical history and 70 of those tried to deliver vaginally.

Results:
Out of 1,060 births there were 19.2 % caesarean sections, from 70 patients who tried to give birth vaginally after caesaren (TOLAC – trial of labour after caesarean) 54.3 % succeeded (the rest gave birth per sectionem caesaream), out of 13 induced labours after caesarean there were only 23.1 % successful. We determined following predictive factors for successful TOLAC: at least one vaginal birth in medical history (p = 0.00), BMI under 35 (p = 0.04) at the time of birth and age under 25 (p = 0.05). We found significant difference in the blood loss between following groups: TOLAC vs deliveries without caesarean in medical history (p = 0.000), TOLAC vs. elective repeat sections (p = 0.000) and successful vs. unsuccessful TOLAC (p = 0.000). We also found significant difference in Apgar score in first and fifth minute between the group of successful TOLAC and unsucessful TOLAC. These results were compared with the current guidelines in UK, USA, Canada, Australia and New Zealand, Germany and Austria.

Conclusion:
This study has brought us data, that should be provided to the patients who think about giving birth in our clinic and who have already caesarean section in medical history.

Key words:
cesarean section – TOLAC – trial of labour after caesarean


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Labels
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine

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