Fetomaternal outcome in patients with previous one lower segment cesarean section, complications with repeat scar and trial of scar.

Abstract

Objectives: The aim of our study is to see the maternal and fetal outcome of pregnancies with previous one lower segment cesarean section. Study Design: Prospective study. Setting: Department of obstetrics and gynecology at DHQ Teaching Hospital Rawalpindi. Period:  1^st July 2018 to 31^st June 2018. Material and Methods: All pregnant women with previous one LSCS and at the gestation of more than 34 week are included after taking consent. Results: 258 patients were included. 132(51.2%) had elective LSCS, 106(41%) had emergency LSCS. 77(29.8%) patients actually took trial of scar, 20(25.9%) patients delivered vaginally. 179 (69.8%) patients had no maternal morbidity. 3(1.2%) patients had peripartum hysterectomy secondary to PPH due to placenta previa. The most common indication for emergency LSCS was fetal distress. The second commonest indication was failure to progress in first stage of labour. 248 (96.1%) of our neonates had good APGAR score(>7 at one minute).We had very low rate for NICU admission, only 10(3.9%) neonates were admitted to NICU. 4 neonates were premature, 5 neonates were admitted due to low birth weight and one with fetal hypoxia. Conclusion: Rate of repeat LSCS is increasing on maternal demand and fetal distress, by careful selection of the patients for VBAC, proper counseling and advanced facilities for monitoring of fetus, repeat LSCS rate can be decreased with associated decrease in maternal and perinatal morbidity and mortality. Comfortable environment and tender loving care during first delivery can decrease the number of patients with refused trial of labour.