Rajiv Gandhi University of Health Sciences s56

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE KARNATAKA

ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

6. /

Brief resume of the intended work

6.1 Need for the study:

The benefits of a successful vaginal delivery as apposed to repeat elective cesarean section drove the much of early enthusiasm for vaginal birth after cesarean section.
A number of studies have compared the risks and benefits of a trial of labour with those of repeat elective LSCS and have also demonstrated the increased risks associated with failed trial of labour.
Therefore a study is required to provide more precise information on outcomes and factors associated with failed and successful trials of labour.
6.2 Review of Literature :
In a prospective observational study it was seen that pregnancy outcomes in women with prior low transverse cesarean delivery maternal morbidity was more with induction of labour as compared with pregnancy outcomes after spontaneous labour.1
A prospective study conducted at Armed force medical college, Pune from 1st January 2001 to 31st December 2003 showed that vaginal birth after cesarean section should be considered in cases of previous one cesarean section for non-recurrent indications.2
A case control study performed showed that prior cesarean section women should be offered vaginal birth AC (VBAC) and women with a prior cesarean and prior vaginal delivery should be encouraged VBAC. A prior vaginal delivery was associated with a lower risk of uterine rupture.3
A predictive scoring system was developed for vaginal birth in cases of previous cesarean section consisting of age of women, vaginal birth history, reason for 1st LSCS, cervical effacement and cervical dilatation. Which stated that increasing scores – correlate with increasing probability of vaginal birth after LSCS.4
A metaanalysis conducted comparing successful trials of labour, elective repeat cesareans and failed trials of labour showed that mothers with successful trials of labour had lowest febrile morbidity and those with failed trial of labour had the highest. 5
6.3 Objectives of the study:
1) To explore about the outcomes and factors associated with failed and successful trials of labour in previous LSCS patients.
2) To compare the perinatal outcomes in successful and failed trials of labour in women with previous LSCS.
7. / Materials and methods:
7.1 Source of data:
The main source of data for the study are patients from the teaching hospitals attached to J.J.M. Medical College, Davangere namely,
· Bapuji Hospital, Davangere.
· Chigateri General Hospital, Davangere.
· Women and Children Hospital, Davangere.
7.2 Method of collection of data (including sampling procedure if any).
100 cases
Women with previous 1 LSCS and no present complications are taken from above hospitals and divided into 2 equal groups.
i) Those who set into spontaneous labour after giving trial of labour (successful trial of labour).
ii) Those who donot set into spontaneous labour even after giving trial of labour and have to be taken for LSCS. (failed trial of labour)

Inclusion criteria :

1) Women with previous 1 LSCS
2) Women with previous 1 LSCS indication being non-recurrent.
3) Women with no associated complications during pregnancy. Eg. APH, PE, HTN, oligohydramnios polyhydramnios, medical disorders etc.
Exclusion criteria :
1) Women with > 1 previous LSCS
2) Women for elective repeat LSCS without giving trial of labour.
3) Women with multiple gestational pregnancy.
4) Women with associated complications during pregnancy.
5) Women with mod and major degree CPD
6) Baby weight > 3.5kg, breech presentation
7) Women at term with high floating head.
PROCEDURE OF STUDY :
1) Women who fulfilled above criteria are given details of study.
2) Informed, written consent is taken.
3) All the cases should be booked in antenatal clinic and regularly reporting for checkup.
4) Labour should ideally be spontaneous in onset but in cases where it failed to set spontaneously even after completion of 41 wks, induction is done.
5) In cases with unfavourable cervix foley’s bulb/cerviprime gel induction is done at night.
6) In morning induction is then started with 5 units oxytocin in 500ml of 5% glucose and increased from 6mlU/min to maximum of 36 mlU/minute. With aim of getting 3-4 uterine contaminations every 10 mins lasting for 40-45 seconds.
7) Labour is monitored by
a) Hourly recording of vital parameters – temperature, pulse, respiration and blood pressure.
b) Monitoring of uterine contractions.
c) A close watch for early recognition of scar dehiscence by identifying maternal tachycardia in absence of vaginal bleeding, scar tenderness and fetal heart rate alterations.
8) Progress of labour is observed meticulously by periodically noting –
a) Progressive descent of fetus
b) Progressive dilatation of cervix
Vaginal delivery is abandoned if there is any suspicion of scar dehiscence or sign of fetal distress or unsatisfactory progress of labour.
Methods of termination of pregnancy :
1) Spontaneous delivery – in cases where progress is smooth (successful trial of labour).
2) Forceps / ventouse – when indicated
3) Cesarean section – in failed trials of labour when any fetal or maternal jeopardy is seen.
7.3 Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so, please describe briefly:
Yes
The study requires routine investigations like,
· Hb%
· Urine for albumin, sugar and microscopy.
· Blood grouping and Rh typing.
· HIV
· HBSAg
7.4 Has ethical clearance been obtained from your institution in case of 7.3?
Yes
8. / LIST OF REFERENCES:
1. Gorbman WA, Gilbert S, Landon MB, Pong YC, Leveno KJ, Rouse DJ et al. Outcomes of induction of labor after one prior cesarean. Obstet Gynecol 2007;109(2):262-9.
2. Shakti V, Behera RC, Sandhu GS, Anita S, Bandhu HC. Vaginal birth after caesarean delivery. J Obstet Gynecol India 2006;56(4):320-323.
3. Macones GA, Peipert J, Nelson DB, Odibo A, Stevens EJ, Stamilio DM et al. Maternal complications with vaginal birth after cesarean delivery : A multicenter study. Am J Obstet Gynecol 2005;193:1656-62.
4. Flamm BL, Geiger AM. Vaginal birth after cesarean delivery: An Admission scoring system. Obstet Gynecol. 1997;90(6):907-911.
5. Rosen MG, Dickinson JC, Westhoff CL. Vaginal birth after cesarean : A meta-analysis of morbidity and mortality. Obstet Gynecol 1991;77(3):465-470.