Decision Making about Mode of Delivery Among Pregnant Women with Previous Cesarean Delivery

Kim, Tae Yoon; Kwon, Hye Kyung; Kim, In Kyu; Yeon, Hye Jung; Han, Sang Won

Abstract

OBJECTIVE
To estimate the rates at which women with a previous cesarean delivery were offered and consented to trial of labor (TOL) and to investigate the factors affecting the decision making about mode of delivery
METHODS
For 12 months duration, pregnant women with one previous cesarean were enrolled prospectively in this study. Eligibility to TOL was defined as pregnancy after 36 weeks of gestation without medical or obstetric indication of cesarean section. Patients were received counseling and consented to the process of TOL. The social and obstetric factors were collected through interview and the medical records were analyzed.
RESULTS
Among the initial 185 patients with one previous cesarean, 106 were considered eligible to TOL. Seventy-two patients out of the 106 delivered with elective repeat cesarean while 34 patients tried TOL; 24 were delivered with vaginal birth after cesarean (VBAC), while 10 were received emergency cesarean section. The indications of cesarean section were cephalopelvic disproportion (CPD, 7 cases) and fetal distress (FD, 1 case). Two received emergency cesarean without definite obstetric indication. The rate of high education, college greaduate or more was higher in the group of TOL than in those of elective cesarean (50% vs 68%, p=0.04). The rates of patients with indication of previous cesarean, CPD, FD, or abnormal placentation were more frequent among the patient with TOL (23% vs 48%, p=0.007).
CONCLUSION
These result provides clinical information about the decision making about mode of delivery among the patients eligible to TOL with one previous cesarean. More clinical studies about TOL and VBAC are required in the different setting of hospital or institute.