INTRODUCTION: An antenatal scoring system for vaginal birth after caesarean section (VBAC) categorises patients into a low or high probability of successful vaginal delivery. It enables counselling and preparation before labour starts. The current study aims to evaluate the role of Grobman nomogram and the Kalok scoring system in predicting VBAC success in Singapore. METHODS: This is a retrospective study on patients of gestational age 37 weeks 0 day to 41 weeks 0 day who underwent a trial of labour after 1 caesarean section between September 2016 and September 2017 was conducted. Two scoring systems were used to predict VBAC success, a nomogram by Grobman et al. in 2007 and an additive model by Kalok et al. in 2017. RESULTS: A total of 190 patients underwent a trial of labour after caesarean section, of which 103 (54.2%) were successful. The Kalok scoring system (area under curve [AUC] 0.740) was a better predictive model than Grobman nomogram (AUC 0.664). Patient's age (odds ratio [OR] 0.915, 95% CI [confidence interval] 0.844-0.992), body mass index at booking (OR 0.902, 95% CI 0.845-0.962), and history of successful VBAC (OR 4.755, 95% CI 1.248-18.120) were important factors in predicting VBAC. CONCLUSION Neither scoring system was perfect in predicting VBAC among local women. Further customisation of the scoring system to replace ethnicity with the 4 races of Singapore can be made to improve its sensitivity. The factors identified in this study serve as a foundation for developing a population-specific antenatal scoring system for Singapore women who wish to have a trial of VBAC.
Area Under Curve ; Cesarean Section ; Female ; Humans ; Infant ; Pregnancy ; Retrospective Studies ; Trial of Labor ; Vaginal Birth after Cesarean

OBJECTIVE: After globally acceptance of planned vaginal birth after cesarean section (VBAC), the mode of induction is still a matter of debate and requires further discussion. We aimed to study obstetric outcomes in post-cesarean patients undergoing induction of labor with prostaglandin gel compared with patients who developed spontaneous labor pains. METHODS: All patients at 34 weeks or more of gestation with previous one cesarean section eligible for trial of labor after cesarean section admitted in a labor room within one year were divided in 2 groups. Group one consisted of patients who experienced the spontaneous onset of labor pains and group 2 consisted of patients who underwent induction of labor with prostaglandin gel. They were analyzed for maternofetal outcomes. Descriptive statistics, independent sample t-test, and chi-square test were applied using SPSS 20 software for statistical analysis. RESULTS: Both groups were comparable in maternal age, parity, and fetal weight, but different in bishop score, mode of delivery, and neonatal outcome. Admisson bishop score was 6.61±2.51 in group 1 and 3.15±1.27 in group 2 (P<0.005). In the patients who experienced spontaneous labor, 86.82% had successful VBAC. In the patients with induced labor, 64.34% had successful VBAC with an average dose of gel of 1.65±0.75. Both groups had one case each of uterine rupture. The neonatal intensive care unit admission rate was 4.1% in group one and 10.4% in group 2. CONCLUSION: This study reflects that supervised labor induction with prostaglandin gel in previous one cesarean section patients is a safe and effective option.
Cesarean Section ; Female ; Fetal Weight ; Humans ; Infant, Newborn ; Intensive Care, Neonatal ; Labor Pain ; Labor, Induced ; Maternal Age ; Parity ; Pregnancy ; Prostaglandins ; Trial of Labor ; Uterine Rupture ; Vaginal Birth after Cesarean

BackgroundIn the mainland of China, the trial of labor after cesarean section is still a relatively new technique. In this study, we aimed to investigate the effects of labor onset, oxytocin use, and epidural anesthesia on maternal and neonatal outcomes for vaginal birth after cesarean section (VBAC) in a tertiary hospital in China.

MethodsThis was a retrospective study carried out on 212 VBAC cases between January 2015 and June 2017 in Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Relevant data were acquired on a form, including maternal age, gravidity and parity, body mass index before pregnancy, weight gain during pregnancy, type of labor onset, gestational age, the use of oxytocin and epidural anesthesia, birth mode, the duration of labor, and neonatal weight. The factors affecting maternal and neonatal outcomes for cases involving VBAC, especially with regards to postpartum hemorrhage (PPH) and fetal distress, were evaluated by univariate analysis and multivariable logistic regression.

ResultsData showed that 36 women (17.0%) had postpartum hemorrhage (PPH) and 51 cases (24.1%) featured fetal distress. Normal delivery took place for 163 infants (76.9%) while 49 infants (23.1%) underwent operative vaginal deliveries with forceps. There were 178 cases (84.0%) of spontaneous labor and 34 cases (16.0%) required induction. Oxytocin was used in 54 cases (25.5%) to strengthen uterine contraction, and 65 cases (30.7%) received epidural anesthesia. The rate of normal delivery in cases involving PPH was significantly lower than those without PPH (61.1% vs. 80.1%; χ = 6.07, P = 0.01). Multivariate logistic analysis showed that the intrapartum administration of oxytocin (odds ratio [OR] = 2.47; 95% confidence interval [CI] = 1.07-5.74; P = 0.04) and birth mode (OR = 0.40; 95% CI = 0.18-0.87; P = 0.02) was significantly associated with PPH in VBAC cases. Operative vaginal delivery occurred more frequently in the group with fetal distress than the group without (49.0% vs. 14.9%, χ = 25.36, P = 0.00). Multivariate logistic analysis also revealed that the duration of total labor (OR = 1.01; 95% CI = 1.00-1.03; P = 0.04) and the gestational week of delivery (OR = 1.08; 95% CI = 1.05-1.11; P = 0.00) were significantly associated with fetal distress in VBAC.

ConclusionsThe administration of oxytocin during labor and birth was identified as a protective factor for PPH in VBAC while birth mode was identified as a risk factor. Finally, the duration of total labor and the gestational week of delivery were identified as risk factors for fetal distress in cases of VBAC. This information might help obstetricians provide appropriate interventions during labor and birth for VBAC.

Adult ; China ; Female ; Gestational Age ; Humans ; Labor Onset ; Odds Ratio ; Oxytocin ; therapeutic use ; Pregnancy ; Retrospective Studies ; Tertiary Care Centers ; statistics & numerical data ; Vaginal Birth after Cesarean ; statistics & numerical data

Pyoderma gangrenosum is an extremely rare chronic cutaneous disease causing severe ulceration. It can be developed after minor trauma or surgical procedure. The typical features mimic acute infection site, however the treatment methods are opposing since pyoderma gangrenosum is improved with the use of corticosteroids, not antibiotic therapy. We here report a patient who had been diagnosed for acute infection after cesarean delivery in 2011 and treated with a number of antibiotics, but failed to recover. The patient had suffered from pain of the disease and also renal failure caused by antibiotics. Ultimately she had been diagnosed as pyoderma gangrenosum and managed successfully with steroids. For her next pregnancy in 2013, we tried vaginal delivery after prior cesarean section and it was uneventful during and after delivery.
Adrenal Cortex Hormones ; Anti-Bacterial Agents ; Cesarean Section* ; Female ; Humans ; Parturition* ; Pregnancy ; Pyoderma Gangrenosum* ; Pyoderma* ; Renal Insufficiency ; Steroids ; Ulcer ; Vaginal Birth after Cesarean ; Wound Infection

Although Cesarean section (CS) itself has contributed to the reduction in maternal and perinatal mortality, an undue rise in the CS rate (CSR) has been issued in Korea as well as globally. The CSR in Korea increased over the past two decades, but has remained at approximately 36% since 2006. Contributing factors associated with the CSR in Korea were an improvement in socio-economic status, a higher maternal age, a rise in multiple pregnancies, and maternal obesity. We found that countries with a no-fault compensation system maintained a lower CSR compared to that in countries with civil action, indicating the close relationship between the CSR and the medico-legal system within a country. The Korean government has implemented strategies including an incentive system relating to the CSR or encouraging vaginal birth after Cesarean to decrease CSR, but such strategies have proved ineffective. To optimize the CSR in Korea, efforts on lowering the maternal childbearing age or reducing maternal obesity are needed at individual level. And from a national view point, reforming health care system, which could encourage the experienced obstetricians to be trained properly and be relieved from legal pressure with deliveries is necessary.
Cesarean Section/*statistics & numerical data/trends ; Data Collection ; Female ; Humans ; *Insurance, Health ; Insurance, Liability ; Maternal Age ; Obesity/epidemiology ; Pregnancy ; Pregnancy, Multiple/statistics & numerical data ; Republic of Korea ; Social Class ; Vaginal Birth after Cesarean/*statistics & numerical data/trends

OBJECTIVE: A proportion of elective repeated cesarean sections where a trial of labor in a uterus with a previous scar was not attempted is on the increase. This study aimed to assess how reduced the use of trial of labor has impacted on neonatal outcomes in the United States. METHODS: Pregnant women with one previous cesarean delivery and a singleton live birth of the index pregnancy were abstracted from the 1995 to 2002 birth registration data of the United States. Adjusted odds ratios for adverse neonatal outcomes of trial of labor were estimated by multiple logistic regression models, in overall study subjects and in the two periods with high and low rates of trial of labor. RESULTS: A total of 1833407 eligible subjects were included in the analysis. Rate of trial of labor after one previous cesarean section dropped from 38.5% in 1995 to 15.0% in 2002. No significant change was observed in the patient population profile. Successful vaginal birth after cesarean delivery (VBAC) also declined from 76.6% in 1995 to 66.0% in 2002. A trial of labor after one previous cesarean section was correlated with increased risks of asphyxia-related neonatal death and neonatal morbidity. This risk was even more pronounced in low risk women and in the last study years with the lowest rate of trial of labor. CONCLUSION The reduced use of trial of labor after one cesarean delivery in recent years in the United States has actually resulted in increased risk of adverse neonatal outcomes associated with a trial of labor.
Adult ; Asphyxia Neonatorum ; epidemiology ; etiology ; Cesarean Section, Repeat ; Female ; Humans ; Infant Mortality ; Infant, Newborn ; Pregnancy ; Trial of Labor ; United States ; epidemiology ; Vaginal Birth after Cesarean ; adverse effects ; statistics & numerical data ; Young Adult

PURPOSE: To examine delivery type of mother who have had a previous cesarean and identify maternal factors related to type of delivery. METHODS: The study sample included 60,504 mothers who had delivered through cesarean section. Related variables were categorized as sociodemographic factors (age, residence, health insurance type, income level) and clinical characteristics (14 maternal factor, 4 fetal factor and pre-term). For data analysis, chi2 and multivariate logistic regression were conducted. RESULTS: Among the 60,504mothers, 3,075 were delivered through Vaginal Birth After C-Section (VBAC) and the VBAC rate was 5.1%. Underage 34, the VBAC rate increased according to age increases up to 3%. Mothers residing in urban areas had VBAC more frequently than mothers in rural area. Mothers in the high and middle income levels had a greater possibility of having VBAC than mothers in lower income levels. A greater likelihood of increase in repeated cesarean section were found in mothers with maternal and fetal factors. CONCLUSION: Evidence based nursing practice guidelines and education programs for previous cesarean section mothers and health policy are needed to increase VBAC.
Cesarean Section ; Evidence-Based Nursing ; Female ; Health Policy ; Humans ; Insurance, Health ; Logistic Models ; Maternal Health Services ; Mothers ; Parturition ; Pregnancy ; Statistics as Topic ; Vaginal Birth after Cesarean

OBJECTIVE: The aim of this study is to determine prognostic factor affecting the mode of delivery in women with one previous low transverse cesarean section by comparing success group with failure group in Vaginal birth after cesarean (VBAC). METHODS: In this retrospective study, 79 patients with one previous low transverse cesarean section who attempted vaginal birth at Jeon-Ju Jesus Presbyterian hospital from January 1, 1997 to December 31, 2007. Information was collected and analyzed to see if there is significant difference between success group and failure group in VBAC. and the significance was set at P<0.05. RESULTS: The VBAC success rate turned out to 88.6%. There was one case of uterine rupture which was associated with hypoxic -ischemic encephalopathy in neonate. But, there was no case of the fetal death or mother death. There were significant difference between two groups in gestational age, expected fetal body weight, cervical dilation, Bishop score, thickness of lower uterine segment. CONCLUSION: The prognostic factors on success of VBAC can be aid in deciding the mode of delivery after cesarean section. Patient being chosen under strict indication, can enhance the VBAC trial and success rate.
Cesarean Section ; Female ; Fetal Death ; Fetal Weight ; Gestational Age ; Humans ; Infant, Newborn ; Lipids ; Mothers ; Parturition ; Pregnancy ; Protestantism ; Quaternary Ammonium Compounds ; Retrospective Studies ; Uterine Rupture ; Vaginal Birth after Cesarean

The American College of Obstetricians and Gynecologists (ACOG) has recommended that the most women with one previous cesarean delivery with a low-transverse incision are candidates for vaginal birth after cesarean and should be counseled about VBAC and offered a trial of labor in the hospital which has physicians immediately available to provide emergency care including cesarean section and personnel familiar with the potential complications of a trial of labor who should be vigilant for nonreassuring fetal heart rate patterns and inadequate progress of labor. The safer VBAC will be provided when the physicians and patients are alert about the risk, benefit and disadvantage of VBAC, and when the reasonable management of the labor is performed. The success of VBAC will contribute to prevent unnecessary primary cesarean and reduce the overall cesarean delivery rate.
Cesarean Section ; Emergency Medical Services ; Female ; Heart Rate, Fetal ; Humans ; Pregnancy ; Trial of Labor ; Vaginal Birth after Cesarean

The American College of Obstetricians and Gynecologists (ACOG) has recommended that the most women with one previous cesarean delivery with a low-transverse incision are candidates for vaginal birth after cesarean and should be counseled about VBAC and offered a trial of labor in the hospital which has physicians immediately available to provide emergency care including cesarean section and personnel familiar with the potential complications of a trial of labor who should be vigilant for nonreassuring fetal heart rate patterns and inadequate progress of labor. The safer VBAC will be provided when the physicians and patients are alert about the risk, benefit and disadvantage of VBAC, and when the reasonable management of the labor is performed. The success of VBAC will contribute to prevent unnecessary primary cesarean and reduce the overall cesarean delivery rate.
Cesarean Section ; Emergency Medical Services ; Female ; Heart Rate, Fetal ; Humans ; Pregnancy ; Trial of Labor ; Vaginal Birth after Cesarean