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- Title
The success rate of vaginal birth after a single caesarean delivery at King Edward VIII Hospital, Durban, South Africa.
- Authors
Daihoum, Rafi k. Moftah; Sebitloane, Hannah M.
- Abstract
Background: There is an increasing trend of caesarean sections (CS) worldwide. The World Health Organization (WHO) recommends that CS should be performed only when medically necessary. One way to reduce this increasing rate is to offer women with a previous single CS an opportunity to attempt a vaginal birth. Little is known about vaginal birth after a single previous caesarean delivery (VBAC) in low- to middle-income countries like South Africa. The objective of this study was to determine the success rate of VBAC at King Edward VIII Hospital (KEH) in Durban, KwaZulu-Natal, South Africa, and investigate reasons for repeat CS in women eligible for VBAC. Methods: This was a cross-sectional study conducted at KEH. Data collected included demographics such as the woman's age, eligibility criteria (maternal weight, estimated foetal weight, LSCS or vertical CS), reason for repeat elective CS, reasons for emergency CS (or failed VBAC) and neonatal outcomes. Results: A total of 3600 records were screened over a period of 6 months and identifi ed 150 fi les of women with a single previous caesarean section (4.2%). Of these, 111 (74%) patients attempted VBAC, with only 37 (33.3%) that were successful. Nine women (6%) refused VBAC and opted for elective CS. Maternal weight signifi cantly affected the success rate of VBAC, where 58% of women with a maternal weight of <95kg were successful, compared to 8% in those who weighed more than 95kg, the latter having median weight of 127.9kg (+/-0.8), p=0.02. Neonatal birth weights were also lighter amongst the successful VBAC, 2.87kg (+/-_0.8), compared to 3.14kg (+/-0.66), p=0.017. The study also showed a discrepancy between the estimated fetal weight and actual birth weights, indicating that ultrasound estimation of fetal weight is often diffi cult in an overweight or obese population. Conclusion: This study found a success rate of 33.3% among women attempting VBAC at a regional hospital in Durban, which was infl uenced signifi cantly by maternal and neonatal weight, where predelivery estimation of fetal weight by ultrasound did not aid the mode of delivery choice. The success rate seems to be signifi cantly lower than the previously reported rate of 50%. Understanding factors contributing to success rate of VBAC is important.
- Subjects
DURBAN (South Africa); SOUTH Africa; VAGINAL birth after cesarean; CESAREAN section; HUMAN fertility statistics; LOW-income countries; FETAL ultrasonic imaging; BIRTH weight
- Publication
Obstetrics & Gynaecology Forum, 2020, Vol 30, Issue 3, p25
- ISSN
1029-1962
- Publication type
Article