Contents lists available at BioMedSciDirect Publications Journal homepage: www.biomedscidirect.com International Journal of Biological & Medical Research Int J Biol Med Res. 2012; 3(2): 1825-1829 Subjective assessment of LSCS scar site for vaginal birth after caesarean trial and outcome in mgims, sevagram, wardha, india a b c d e Pramod Kumar, Poonam Varma Shivkumar, Arpita Jaiswal, Naina Kumar, Kavita Saharan A R T I C L E I N F O ABSTRACT Keywords: Trial of scar Subjective assessment Caesarean section rate VBAC. Short report 1. Introduction Abstract: The objective of this study was to determine the final outcome of a trail of scar by subjective assessment of LSCS scar site and vaginal birth after caesarean section (VBAC), and develop guidelines to reduce the unnecessary repeat caesarean rate. Method: This study was carried out in Obstetrics and Gynaecology Department of MGIMS, Sevagram, Wardha, India from 01/11/2008 to 31/10/2011. A total of 13, 175 parturient were delivered during this period, out of which 1485 cases had history of one previous caesarean section. A total of 249 patients had an elective repeat caesarean section and rest of 1236 were subjected to a trial of scar. Result: 1236 patients selected for trial of scar, 846 (68.4%) had a successful uncomplicated vaginal delivery, 65(5.2%) were delivered by vacuum extractor, 38(3.2%) required a repeat emergency caesarean section, 73.9% of the babies were born with Apgar score 78 and 24.8% had an Apgar score between 6-8. There were none cases of scar dehiscence and rupture uterus and one baby was lost due to congenital malformation. Conclusion: More than 76% of the parturient with one previous caesarean section for non-recurrent cause can be successfully delivered. Antenatal booking and follow up, careful case selection for trial of scar and close observations during labour will achieve successful maternal and perinatal outcome. The caesarean section rate has increased, both in the developed and developing countries alike. It is partly due to availability of safe anaesthesia, excellent blood transfusion services, and advances in operative technology and development of broad spectrum antibiotics. The relative safety of the operative procedure had led to relaxation of indications, resorting to the procedure for relative indications and even 'caesarean on demand' by some women. This tendency needs to be controlled as it puts a great drain a health care resources, is costly and associated with serious risks to the mother and baby, all the recent advances notwithstanding. This rising caesarean section rate has created and expanding high risk obstetric sub-population “Women with scarred uterus.” [1-6]. Risk of rupture of uterus in subsequent pregnancy led Craigin to introduce the concept “Once a caesarean, always a caesarean” in 1916. This concept met a lot of criticism both in the West and East and most obstetricians now favour a trial of scar policy in well equipped hospital for women who have undergone a caesarean section for non-recurrent cause [7, 8]. The safety of vaginal birth after caesarean section (VBAC) has been shown but there are no reliable methods to predict the risk of uterine rupture in these patients. Studies have shown that ultrasonography (USG) may predict uterine rupture in women with previous caesarean delivery. The risk of uterine rupture in the presence of an LSCS scar is related directly to the degree of thinning of the lower uterine segment (LUS). Although LUS thickness as measured by sonography at or near term is being used by 16% of obstetricians in Canadato determine which women are good candidates for VBAC, the value of applying sonographic LUS thickness measurement in the management of VBAC remains unclear and there are no clear guidelines in this regard [9, 10]. BioMedSciDirect Publications Copyright 2010 BioMedSciDirect Publications IJBMR - All rights reserved. ISSN: 0976:6685. c International Journal of BIOLOGICAL AND MEDICAL RESEARCH www.biomedscidirect.com Int J Biol Med Res Volume 2, Issue 4, Jan 2012 a Assistant Professor, Obstetrics & Gynaecology, Mahatma Gandhi Institue of Medical Science, Sevagram. b Professor & Head, Obstetrics & Gynaecology, Mahatma Gandhi Institue of Medical Science, Sevagram. c Assistant Professor, Obstetrics & Gynaecology, Mahatma Gandhi Institue of Medical Science, Sevagram. d Assistant Professor, Obstetrics & Gynaecology, Mahatma Gandhi Institue of Medical Science, Sevagram e Post graduate, Obstetrics & Gynaecology, Mahatma Gandhi Institue of Medical Science, Sevagram * Corresponding Author : Pramod Kumar Girls hostel sewagram wardha, India 9665125415 kaviben@gmail.com Copyright 2010 BioMedSciDirect Publications. All rights reserved. c