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Objectives

Previous One caesarean section. Dr Zakia Balghari, Mr Nicola Comi, Mr Mohammed Ibrahim Newham University Hospital Barts Health NHS Trust, London E13 8SL. what happens next??. Methods. Results. Objectives. Conclusions. A retrospective audit over a period of one year. Settings:

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Objectives

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  1. Previous One caesarean section Dr Zakia Balghari, Mr Nicola Comi, Mr Mohammed IbrahimNewham University HospitalBarts Health NHS Trust, London E13 8SL . what happens next?? Methods Results Objectives Conclusions A retrospective audit over a period of one year. Settings: A tertiary care maternity unit with 6000 deliveries per annum. Population: All women with one previous CS from August 2008 to August 2009. Case notes and Electronic patient record (EPR) identified through antenatal booking, taken against Central Delivery Suite delivery data. Analysis by Standard MS excel. • Total 235 women with previous one CS. • VBAC offered: 184 • VBAC accepted: 153 (67%) • Emergency CS: 82 (53%) • Successful VBAC: 72 (47%) • Overall CS rate during the audit period was 28 %. • CS rate in previous 1 CS was 68.1% • Indications of emergency CS were mainly presumed fetal compromise 36%,Failure to progress 25%,maternal request • 15%,medical disorders 6%,scar tenderness 6%. • 16 women had IOL • Among them successful VBAC rate: 44%. • Emergency CS rate: 56% with comparable complications rate. • Establish and support dedicated VBAC clinics. • To reduce elective CS for maternal request and emergency CS due to change in mind during labour by improving counselling and better support and communication. • To set a standard gestation for elective CS in women who want to wait for vbac unless indicated. • To consider IOL and augmentation of labour in appropriately selected women. • -To find out the rate of uptake and success of VBAC, reasons for emergency CS during trials of VBAC in women with one previous CS. • -To identify ways to reduce the rising rate of caesarean in women with previous one CS. • Main outcome measures: • - VBAC uptake rate. • - reasons for not offering or declining VBAC. • - vbac success rate. • - Reasons of emergency CS during VBAC trial. • - out come of Induction of Labour IOL,a subgroup analysis. • - comparison of elective CS,emergency CS and successful VBAC groups. References • -Birth after previous Caesarean birth; Green Top Guideline no 45, RCOG • Local Guideline for Caesarean section and VBAC; Newham University Hospital ,NHS Trust

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