Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




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Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




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"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
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Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2010 | Month : February | Volume : 4 | Issue : 1 | Page : 2005 - 2009

Outcome of a Post Caesarean Pregnancy in a Tertiary Center of a Developing Country

BHAT BPR **, SAVANT R *, KAMATH A***

*(D.G.O),** (M.D),*** (M.D) Department of Obstetrics and Gynaecology, Father Muller Medical College, Kankanady,Mangalore - 575 002,Karnataka,(India)

Correspondence Address :
B. Poornima Ramachandra Bhat,
Assistant Professor, Dept of
Obstetrics and Gynecology,Father
Muller Medical College, Kankanady,
Mangalore - 575 002, Karnataka, (India)Fax: 0824-2437402Email:
bprbhat@rediffmail.com,Tel no.:+91
94489 53435

Abstract

Background: An expectant attitude and individualization with respect to the management of pregnancy and labour in patients who had one caesarean section is not only justifiable, but represents sound and conservative obstetrical practice.
Aims:
1. To study the success rate of vaginal birth after caesarean delivery
2. To know the commonest indication for elective and emergency caesarean section
Methods: A total of 219 cases with a history of previous caesarean section beyond 28 weeks of gestation were included in the study. The collected data was analyzed by chi-square test.
Results:The incidence of post caesarean pregnancy cases were 219(8.76%). Out of these, 113 (51.6%) were selected for trial of labour and 106(48.4%) underwent elective repeat caesarean section. Of the 113 women who were allowed for a trial of labour, 73(64.6%) delivered vaginally and 40(35.4%) delivered by emergency repeat caesarean section. Thus, the success rate of VBAC was 64.6%. So a total of 146(66.7%) women underwent repeat caesarean section and 73(33.3%) delivered vaginally. Cephalopelvic disproportion was the most common indication for elective repeat caesarean section and foetal distress for emergency caesarean section.
Conclusion: VBAC should be considered in cases of previous one caesarean delivery for non recurrent indications.

Keywords

Vaginal birth after caesarean section, repeat caesarean section, trial of labour, scar dehiscence, maternal morbidity.

Introduction
For many decades, a scarred uterus was believed to contraindicate labour, out of fear of uterine rupture. In 1916, Craigin pronounced “Once a caesarean always a caesarean”. The year 1978 was a milestone in the history of prior caesarean delivery. Merill and Gibbs (1) reported that subsequent vaginal delivery was safely attempted in 83% of their patients with prior caesarean deliveries. This report served to rekindle interest in vaginal birth after prior caesarean (VBAC). The realization of ever increasing caesarean rates and that a carefully monitored attempt at vaginal delivery in previous caesarean delivery cases is indeed safe has propagated this concept greatly.

There is wide variation in the VBAC rates pronounced by hospitals and physicians. The present study was undertaken to re-ascertain these facts with the hope that more women will be encouraged to avoid an unnecessary repeat caesarean section by opting for vaginal delivery.

VBAC offers distinct advantages over repeat caesarean section, since the operative morbidity and mortality are completely eliminated, the hospital stay is much reduced and the expenses involved are much less. The rate of caesarean section needs to be reduced and this can be achieved to a small extent by avoiding a primary caesarean section done without explicit indications and more importantly, by resorting to a trial of vaginal delivery after previous caesarean section, which is safe for the foetus(2).

Material and Methods

This descriptive study was conducted from 1st January 2007 to 31st January 2008. All patients with a history of previous caesarean section beyond 28 weeks were included. Complete history including indication of previous caesarean section, the details of the present pregnancy, foetal size, amount of liquor, scar tenderness, pelvic adequacy and any other disorders were recorded.

The patients were followed up from admission to discharge from the hospital. The mode of delivery, morbidity (maternal and neonatal) and mortality were noted. Patients with a history of previous caesarean section who were not given the trial of labour underwent elective repeat caesarean section (ERCS). The ERCS group also included those patients who were not allowed the trial of labour (TOL) and had repeat caesarean section, although the caesarean section was done on an emergency basis. Patients who had a failed trial of labour underwent emergency caesarean section. These were included in the emergency section group. This study was approved by the institutional ethical committee. The collected data was analyzed by chi-square test.

Results

During the study period, there were a total of 2498 deliveries out of which 219 women had a previous caesarean section, which constitutes 8.76% of the patients. Of the 219 women with a previous caesarean section, 113(51.6%) were selected for the trial of labour and 106(48.4%) underwent elective repeat caesarean section (p=0.636, not significant).

Of the 113 women who were allowed a trial of labour, 73(64.6%) delivered vaginally and 40(35.4%) delivered by repeat caesarean section. Thus, the success rate of vaginal birth after caesarean section delivery was 64.6% (p=0.002, highly significant). 73(33.3%) women delivered vaginally and 146(66.7%) underwent repeat caesarean section (p=0.000, highly significant) out of the 219 cases with previous caesarean section.

The study shows that 4(5.4%) delivered by vacuum application out of the 73(33.3%) vaginal deliveries. The indication for vacuum application was foetal distress in three cases and the failure of maternal bearing down efforts in one case.

Cephalopelvic disproportion (CPD) was the most important indication for elective repeat caesarean section, accounting for 49% of elective repeat caesarean section, (Table/Fig 1) [Table 1, x2=96.755,p=0.000] , whereas foetal distress (37.5%) was the most common indication in the emergency caesarean section group (Table/Fig 2) [Table 2, x2=23.7, p=0.01].

Of those 12 women whose primary caesarean section was done for CPD, 75% delivered vaginally, whereas 70.5% and 64% of women who underwent primary caesarean section for foetal distress and malpresentation respectively, delivered vaginally (Table/Fig 3) [Table 3, χ2=7.457, p=0.488 not significant].

73% of the women with previous caesarean section, who also had a prior vaginal delivery, delivered vaginally, as compared to 62% of the women who did not undergo prior vaginal delivery. This difference was statistically not significant. Out of the 82 women who were in spontaneous labour, 67% delivered vaginally, where as out of the 20 who were induced with oxytocin, 45% delivered vaginally. This is not statistically significant.

Women who underwent emergency caesarean section had more intra operative complications like bladder injury, extension, haematoma etc. than those who had elective repeat caesarean section. This was statistically significant (p=0.041). 3(2.65%) cases of scar dehiscence were found in 113 patients who were allowed the trial of labour. There were no cases of uterine rupture. Though emergency caesarean section was associated with a 20% maternal morbidity as compared to 9.5% with vaginal delivery and 10.3% with elective repeat caesarean section, this is not a statistically significant difference.

In the majority of the cases where repeat caesarean section was performed, the babies weighed more than 3 kg, whereas in the vaginal delivery cases, the babies weighed less than 3 kg. This was statistically significant (p=0.01).

Emergency caesarean section was associated with 20% perinatal morbidity as compared to 16.4% for vaginal delivery and 1.8% for elective repeat caesarean section. This was statistically significant (p=0.000). There were no perinatal deaths in this study.

Women who had a successful vaginal delivery had a significantly lesser duration of hospital stay as compared to those who had a caesarean section (p=0.0005 highly significant).

Discussion

There has been a steady rise in cases with previous caesarean section over the past few decades. Miller et.al.(3) reported a post caesarean pregnancy rate of 8.1% in 1983 and 14.1% in 1992. Our study showed a post caesarean pregnancy rate of 8.7%. Published literature shows that there has been 70 to 80% success in attempts at VBAC (2),(3),(4),(5),(6),(7). We had a 64.6% success in those who had trial of labour. Aisien et.al.(8) reported a 48.1% incidence of vaginal delivery in previous caesarean section cases, whereas Chabra et.al reported an incidence of 32.4% (9). Our study reported a 33.3% incidence of vaginal delivery in previous caesarean section cases.

Miller et.al. reported a 2.3% incidence of women with multiple caesarean section (3), whereas our study showed the incidence to be 5.6%. Singh et.al reported a 92.8% success rate in vaginal delivery with oxytocin induction (10), whereas our study reported a lower success rate of 58%. The incidence of instrumental delivery in our study was 5.4% as compared to 12.6% and 10.7% reported by Singh et.al (7) and Shah et. al (10), respectively.

Miller et. al. had reported vaginal delivery in 52% of those with CPD, 84% in those with breech presentation and 54% in those with foetal distress as indication of previous caesarean section (3). Our respective figures were 75%, 66.6% and 70.5% in the 3 cases.

In the present study, intraoperative complications like haematoma, bladder injury etc. were found in 57.5% of the cases of the emergency caesarean group as compared to 38.6% of the elective repeat caesarean section group. This was statistically significant (p=0.041). Scar dehiscence was found in 3(2.65%) cases during emergency repeat caesarean section. In all the three cases, oxytocin was not used. There were no cases of scar rupture in our study. Singh et. al. reported a scar dehiscence rate of 1.67%10 .Carolyn et.al in their study of women with previous caesarean section, reported uterine rupture rate of 2.3% in those induced with oxytocin or PGE2 gel as compared to 0.7% among women with spontaneous labour (11). In patients receiving oxytocin augmentation, the rate of uterine rupture was 1.0% as compared to 0.4% in the non- augmented, spontaneously labouring patients. Locateli et.al reported a uterine rupture rate of 0.3% in women with previous caesarean section as compared to 0.03% in the intact uterus group (12). They concluded that induction of labour is not associated with significantly higher rates of uterine rupture among women with previous low transverse caesarean section as compared to women with intact uterus, provided that a consistent protocol with strict intervention criteria is adopted.

In our study, the incidence of febrile morbidity in the emergency caesarean section group was 10%, while that in the elective repeat caesarean section was 1.8%. In another study, the incidences were 5.3% and 6.4% for the respective groups (13). In our study, the incidence of wound infection in the emergency caesarean section group was 5%. There were no cases of wound infection in the elective repeat caesarean section group. McMohan et al (13) reported an incidence of 2.2% in the elective repeat caesarean section group and 1.3% in the emergency caesarean group. In our study, 3.7% of the patients from the elective repeat caesarean section group, 2.7% from the vaginal delivery group and none from the emergency caesarean group required blood transfusion. In the study by McMohan et al (13), 1.1% and 1.3% patients required blood transfusion in the emergency caesarean and elective repeat caesarean section groups, respectively.

Aisien et.al reported one maternal mortality case as a result of uterine rupture and post partum haemorrhage which gave a case fatality rate of 0.3% 8. There was no maternal mortality in our study. Overall, there was no statistically significant difference in the maternal morbidity in the various groups.

The average length of stay was 4 days in the patients who delivered vaginally as compared to 7 days in those who had elective and emergency caesarean section. This was comparable with other studies.

There was no neonatal mortality in our study. When other measures of neonatal outcome were examined in the study, a higher incidence of birth asphyxia was recorded after failed trial of labour than after vaginal delivery. Emergency caesarean section was associated with higher perinatal morbidity than vaginal delivery and ERCS. This was comparable to the study by Brenda et.al (14).The present study shows that neonatal outcome was not adversely affected by VBAC.

Among women with one previous caesarean section and one previous vaginal delivery, those whose most recent delivery was vaginal, had a lower rate of caesarean delivery and shorter duration of labour than those whose most recent delivery was caesarean (15). Our study did not find such a correlation.

To conclude, an expectant attitude and individualization with respect to the management of pregnancy and labour in patients who had one caesarean section is not only justifiable, but represents sound and conservative obstetrical practice. Operative interference will be made in time if complications like foetal or maternal distress or threatened rupture etc. comes into the picture. All women undergoing a trial of labour should be carefully monitored during labour. Substantial reduction in the caesarean rate can be achieved safely and efficiently by encouraging the trial of labour in women with a single previous caesarean delivery.

Key Message

Substantial reduction in the caesarean rate can be achieved safely and efficiently by encouraging trial of labour in women with a single previous caesarean delivery.

References

1.
Merill BS, Gibbs CE. Planed vaginal delivery following caesarean section. Obstet Gynecol. 1978; 52:50-2.
2.
Vardhan S, Behera RC, Sandhu GS, Singh A, Bandhu HC. Vaginal birth after caesarean delivery. J Obstet Gynecol India 2006; 56(4):320-3.
3.
Miller AD, Diaz FG, Paul RH. Vaginal birth after caesarean: A 10 year experience. Obstet Gynecol 1994; 84:255-8.
4.
Tan PC, Subramaniam RN, Omar SZ. Lab our and perinatal outcome in women at term with one previous lower segment caesarean: A review of 1000 consecutive cases. Aust NZJ Obstet Gynecol 2007; 47(1):31-6
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Ola ER, Imosemi OD, Abudu OO. Vaginal birth after one previous caesarean section- evaluation of predictive factors. Afr J Med Sci 2001; 30(1-2):61-6.
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Martin JN, Perry KG, Robert WE, Megdrech E. The case for trial of labour in the patients with prior low segment vertical caesarean section. Am J Obstet Gynecol, 1997;177:144-8
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Shah JM, Mehta MN, Gokhale AV. Vaginal birth after caesarean delivery. Obs. & Gynae. Today 2007; 12(6):280-1.
8.
Aisien AO, Oronsaye AU. Vaginal birth after one previous caesarean section in a tertiary institute in Nigeria. J Obstet Gynaecol.2004; 24(8):886-90.
9.
Chhabra S, Arora G. Delivery in women with one previous caesarean section. J Obstet Gynecol India 2006; 56(4):304-7.
10.
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