DOI: https://doi.org/10.53350/pjmhs22169323 ORIGINAL ARTICLE P J M H S Vol. 16, No. 09, September, 2022 323 Frequency of Cesarean Section in Patients with Previous One Scar ASIA ASGHAR 1 , SADIA HABIB 2 , NIMRA NAEEM 3 , HADIA HUSSAIN 4 , SUNDUS NAWAZ 5 , MAJIDA ZAFAR 6 1,4 Postgraduate Trainees ”Unit B”, 2 Associate Professor/Chairperson, 3,5 Postgraduate Trainees, Department of Obstetrics & Gynaecology "Unit C" Auyb Medical Teaching Institute (AMTI) Abbottabad 6 Assistant Professor, Department of Obstetrics & Gynaecology, MCH Center, Pakistan Institute of Medical Sciences (PIMS), Islamabad Correspondence to: Sadia Habib, Email: sadiazeb@yahoo.com, Cell: 0333-5033929 ABSTRACT Objective: To determine the frequency of cesarean section in patients with previous one scar. Study Design: Cross-sectional study. Place and Duration of Study: Department of Obstetrics and Gynaecology, ATH, Abbottabad from 1 st June 2020 to 30 th November 2020. Methodology: One hundred and thirty pregnant women with previous one scar were included in the study. All participants were managed as per department protocol and frequency of cesarean section was noted. Results: The age range was from 18 to 35 years with mean age of 29.361±1.95 years, mean gestational age 38.592±1.26 weeks, mean parity 1.923±0.91 and mean weight was 70.776±4.20 kg. Cesarean section was seen in 25.4% patients. Conclusion: Prior scar women are at higher risk of caesarean section unless the type of delivery method. Keywords: Pregnancy, Previous one scar, Cesarean section INTRODUCTION Caesarean section is a common delivery method in pregnant females and its frequency varies from 1-52% in different regions of the world. 1 Prior C-section escalates the chances of caesarean delivery again in women however few women gave vaginal birth as well. This divergence is also varied in all over the globe accounting 9% in America and ~50 in UK. 2 Various social, medical and psychological factors taken into account before the consideration of delivery method. Children outcomes and consequences are also different in different modes of delivery method. Vaginal delivery after previous C-section give rise to many problems due to uterine scar and higher chances of rupture. Offspring may have elevated risk of hypoxic brain injury which can cause cerebral palsy and even death in few cases. Cerebral palsy due to vaginal birth after C-section accounts in 2-10% of all the cases. 3,4 Although C-section avoid such associated risk but fetus does not get benefited from maternal bowel flora exposure due to vaginal delivery. Research suggested that, exposure to maternal flora increases the defense mechanism of the newborn and the development of gut’s microbiome. 5 The reasons for the increase in CS are multifactorial, but existing literature suggests that the increase is predominantly a result of advanced maternal age, particularly in nulliparous women. 6 In most of the industrialized world, social, educational and demographic changes have led to an increasing number of women postponing their pregnancies until late in their fertile life. 7 In a study by Sangwan et al 8 have showed that frequency of cesarean section was 20.9% in women with previous scar. There is paucity of data in this subject in our local population. As its discussed above that attempting VBAC after a previous cesarean section has increased risk of uterine scar rupture, therefore its necessary to get local evidence regarding frequency of cesarean section in patients with previous one scar. Moreover, in order to ensure that birth choices are informed, research is needed into long-term health outcomes in children born by CS, with particular focus on those born to women with a history of CS. MATERIALS AND METHODS This cross-sectional study was conducted at Department of Obstetrics and Gynaecology, ATH, Abbottabad from 1 st June 2020 to 30 th November 2020 and 130 women were enrolled. All women age 18-35 years, singleton pregnancy on ultrasound, gestational age 36-41 weeks on LMP, parity 1-4 and previous one scar were included. Non cephalic, placenta previa, known or suspected disproportion of maternal and/or fetal origin and history of tumor of corpus uteri were excluded. Base line demographic information of patients (age, parity, gestational age, weight by weighing machine, type of scar) was taken. Informed consent was taken, ensuring confidentiality and fact that there was no risk involved to the patient while taking part in this study. All participants were managed as per department protocol and frequency of cesarean section was noted. The data was entered and analyzed with SPSS-22. RESULTS The meanswere of age 29.361±1.95 years, mean gestational age 38.592±1.26 weeks, mean parity 1.923±0.91 and mean weight was 70.776±4.20 kg (Table 1). According to type of scar, 99 (76.2% women have C-section and 31 (23.8%) women have myomectomy (Table 2). Thirty-three (25.4%) women have cesarean section and 97 (74.6%) women have no cesarean section (Table 3). Table 1: Descriptive statistics of patients (n=130) Variable Mean±SD Age (years) 29.36±1.95 Gestational age (weeks) 38.59±1.26 Parity 1.92±0.91 Weight (Kg) 70.77±4.20 Table 2: Frequency of type of scar (n=130) Type of Scare No. % C section 99 76.2 Myomectomy 31 23.8 Table 3: Frequency cesearean section (n=130) Type of Scare No. % Yes 33 25.4 No 97 54.6 DISCUSSION American college of obstetrician and gynecology suggested the concept of cesarean section. This highlighted the importance of vaginal delivery despite of the prior C-section. According to it, women should be counselled and encouraged to give abdominal delivery as it is more beneficial for the newborn. 93 New research elaborated this fact that, lower segment caesarean section cannot be problematic for labor induction by oxytocin however, prostaglandin can sometime cause adverse reaction. A prospective study was conducted by the University of South Carolina to determine the safety and success rate of vaginal delivery after C-section. Vaginal delivery was observed more frequently in spontaneous group in contrast to induced labor group. Uterine scar separation was also higher among induced group as compared to elective c-section. Results of this study showed that maternal morbidity chances were also higher in vaginal delivery group after c-section. 9 Another study conducted by Rageth et al 10 concluded that, chances of uterine rupture was very high who had prior history of caesarean section in both types of caesarean delivery (spontaneous versus elective C-section). A study conducted by