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Objectives

Vaginal Birth after Caesarean section – Acceptability and outcome in an East London University Hospital Ruwaisa Aliyar, Fiona Fong, Baha Khan, Sujatha Thamban and Dilip Visvanathan

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Objectives

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  1. Vaginal Birth after Caesarean section – Acceptability and outcome in an East London University Hospital Ruwaisa Aliyar, Fiona Fong, Baha Khan, SujathaThamban and DilipVisvanathan Barts Health NHS Trust - Whipps Cross University Hospital – Whipps Cross Road, Leytonstone, London E11 1NR It was surprising that all 7 women with a previous vaginal delivery declined VBAC. Uterine rupture was seen in two women but with normal maternal and fetal outcomes. 18 women (9%) had postpartum haemorrhage. Surprisingly 45% were in women with a normal vaginal delivery. Five babies (four for abnormal cord pH) were admitted to SCBU. There were 20 babies with a birth weight over 4 Kg. The VBAC success rate in this group was 80%. Objectives Results Our counselling involves quoting an increased incidence of haemorrhage for LSCS but this was not borne out by our results. We also did not see a higher failure rate with a birth weight greater than 4Kg. This may be explained by regional and unit variations. Women with previous vaginal births did better (in line with current figures) but again there were high numbers that declined VBAC. We now wish to study reasons for women declining VBAC in an attempt to evaluate if we can improve our uptake rates of 60%. Women’s choice of a vaginal birth after caesarean section (VBAC) will help reduce the increasing lower segment caesarean section (LSCS) rates. Counselling for VBAC is important and a dedicated clinic was set up to address this. The objective of this audit was to determine the acceptability and outcome of VBAC in our setting. The age range was 16-47 (average 32.6) years. Parity ranged from 1-8. 118 women were Para 1, 45 were Para 2, 26 were Para 3 while 11 women were Para 4 or above. 116 women had one previous LSCS with five women having a previous vaginal birth. In this group, 66 (60%) women accepted a VBAC with 38 (58%) women achieving it. VBAC was achieved in all women with previous vaginal birth. 12 women (10%) had labour induced – only 2 had a successful VBAC. 31 women had 2 previous LSCS, of which 7 women had a previous vaginal birth. Six women (19%) opted for a VBAC with only one woman (17%) achieving it. Methods 200 consecutive women over a 4-month period (July to November 2011) with previous LSCS were identified and the outcomes of their pregnancies were obtained by using the birth register. Conclusions A 58% success rate is far less than the 72-76% RCOG quoted figure but did not account for factors such as high BMI and previous LSCS for dystocia which can reduce this figure to 40%. References Birth After Previous Caesarean Birth. Green-top guideline No. 45 Feb. 2007. Royal College of Obstetrician and Gynaecologiists.

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