Hospital maternal morbidity associated with trial of labor after cesarean section vs elective repeat cesarean delivery at Muhima DH and Kigali University Teaching Hospital ( KUTH)

Abstract

ntroduction Before the 1970s, deliveries by cesarean section were considered as indication for cesarean section in the subsequent pregnancies, reflecting a concern that uterine scar tissue might rupture during labor. Offering trial of scar and subsequent vaginal delivery can contribute to reduction of the rate of caesarean section. There are benefits and harms associated with both repeat elective caesarean birth and vaginal birth after caesarean section. Objective: The objective of this study was to compare the hospital maternal morbidity associated with trial of labor after cesarean section and the hospital maternal morbidity associated with elective repeat cesarean delivery. Methods: This was a prospective cohort study. Results: Genital tract injury/urinary tract injury was 0% in group of TOL and 1 mother (1%) in group of ERCS (OR 1.010; P < 0.001).Transfusion 1.9% in TOL group and 1% in the ERCS group (OR 1.83; P < 0.001). Uterine rupture and hysterectomy each 0.9% in TOL group and none in ERCS group (OR 1.916; P < 0.001). Wound infection 0.9% in TOL group and 4.1% in ERCS group (OR 0.22; P< 0.001). The maternal morbidity occurred in 3 mothers (2.8%) in group of TOL Vs 6 mothers (6.1%) in group of ERCS (P<0.001; OR 0.438). In group of TOL, on 5th minute, 107 neonates (99.1%) had an APGAR score between 10-8 and only one neonate (0.9%) had an APGAR score between 7-6 while in group of ERCS at the same time, 98 neonates (100%) had an APGAR score between 10-8, none have been recorded to have an APGAR score between 7-6. One neonate (0.9%) who have been admitted to neonatology unit was in group of TOL while none neonate have been recorded in group of ERCS (OR 0.991; 95%CI 0.973 to 1.009). ix Conclusion of our study  There is a high risk of maternal morbidity in group of ERCS compared to the group of TOL.  The TOL is safer compared to ERCS regarding repercussion to maternal morbidity.  There is no difference in both groups (TOL and ERCS) in an APGAR score of neonates at 5 minutes.  There is no difference in both groups (TOL and ERCS) to be admitted in the neonatology unit. Recommendations - Medical providers of Muhima DH and KUTH should continue to encourage mothers who had prior caesarian section to try labor; - Medical providers should early diagnose and treat maternal complications associated to chosen mode of delivery; - Prospective study should be done on long term maternal morbidity associated with ERCS and TOL in Rwanda.