Awi, I.

Haris Njoo, Suharjono

Kyaing, Yee Yee

Mardiana, Binti Kipli

Mya, Kyawswa

The research aimed to study outcomes of trial of labour in women with a previous LSCS scar in Maternity Unit, Sarawak

General Hospital, Malaysia, 2010 and it was designed as retrospective study by reviewing records of pregnant women with a

previous caesarean section scar without prior vaginal delivery. Out of 390 women, successful vaginal delivery rate (VBAC)

was 53.3%. Blood loss among successful group were significantly less than that of failed group (p=0.018) but blood transfusion

was not significantly different between these two groups (p=0.258). Successful VBAC rate was significantly higher in the

group of foetal weight between 2.5 to 3.5 Kilogram comparing to the group of more than 3.5 Kilogram (p=0.048). Newborns

with Apgar score less than 7 after 1 minute of delivery were more common in failed VBAC than successful VBAC (p=0.026).

NICU admission were higher in the group of preterm pregnancy (p <0.001). The study concluded that success rate was

about fifty percent. Foetal birth weight was a significant factor for successful VBAC. These results should be considered in

trial of labour

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* To whom correspondence should be addressed.Malays. Appl. Biol. (2018) 47(1): 167–172MATERNAL AND FOETAL OUTCOMES IN TRIAL OF LABOURWITH A PREVIOUS LOWER SEGMENT CAESAREAN SECTIONSCAR AT SARAWAK GENERAL HOSPITAL, 2010YEE YEE KYAING1*, AWI ANAK IDI1, MARDIANA BINTI KIPLI1, HARIS NJOO SUHARJONO2and KYAWSWA MYA31Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences,University Malaysia Sarawak, 93400, Kota Samarahan, Sarawak, Malaysia2Department of Obstetrics and Gynaecology, Sarawak General Hospital,93000, Kuching, Sarawak, Malaysia3Department of Biostatistics, University of Public Health, Yangon, Myanmar*E-mail: ykyee@unimas.my, yeekyaing@gmail.comAccepted 21 February 2018, Published online 31 March 2018ABSTRACTThe research aimed to study outcomes of trial of labour in women with a previous LSCS scar in Maternity Unit, SarawakGeneral Hospital, Malaysia, 2010 and it was designed as retrospective study by reviewing records of pregnant women with aprevious caesarean section scar without prior vaginal delivery. Out of 390 women, successful vaginal delivery rate (VBAC)was 53.3%. Blood loss among successful group were significantly less than that of failed group (p=0.018) but blood transfusionwas not significantly different between these two groups (p=0.258). Successful VBAC rate was significantly higher in thegroup of foetal weight between 2.5 to 3.5 Kilogram comparing to the group of more than 3.5 Kilogram (p=0.048). Newbornswith Apgar score less than 7 after 1 minute of delivery were more common in failed VBAC than successful VBAC (p=0.026).NICU admission were higher in the group of preterm pregnancy (p <0.001). The study concluded that success rate wasabout fifty percent. Foetal birth weight was a significant factor for successful VBAC. These results should be considered intrial of labour.Key words: Lower segment caesarean section (LSCS), Trial of labour after caesarean section (TOLAC), Vaginalbirth after caesarean section (VBAC)INTRODUCTIONCaesarean section rates across the world have beengradually increasing for decades, seeminglyunstoppable. In UK, the rate was 12% in 1990, 20%in 2001, 24% in 2008, 26.9% in 2013, 29.1% in2014 and still rising despite efforts to reduce it(Index of National Maternity Statistics, n.d). In2011, caesarean section rate in Australia was 32%,while in New Zealand it was 23.6% (Birth afterprevious caesarean section-RANZCOG, 2010). In theUnited States the caesarean section rate reached32.2% in 2014 (Hamilton et al., 2015). China hasone of the highest caesarean section rates in theworld with 16 million babies or approximately 50%of babies born in 2010 were delivered by caesareansection (Hellerstein et al., 2015).Increasing rates of primary caesarean sectionhave led to an increased proportion of the obstetricpopulation who has a history of prior caesareandelivery and therefore pregnant women with aprevious caesarean section have to face with thechoice of either TOLAC or ERCD. London MB etal. did a prospective four-year observational studyat 19 academic medical centers comparing maternaland perinatal outcomes between women whounderwent a trial of labour and an elective repeatedcesarean delivery. After that they concluded asTOLAC was associated with a greater perinatalrisks than ERCD in 2004 (Landon et al., 2004).Moreover, according to the review of nationalmaternity hospital data base and national registryof perinatal deaths by Smith et al. (2005) alsoconcluded that there was increased risk of uterineruptures which leading to perinatal deaths inTOLAC who had increased risk of emergency LSCS.

Maternal and Foetal Outcomes in Trial of Labour with a Previous Lower Segment Caesarean Section Scar at Sarawak General Hospital, 2010

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