[Advantages and risk of a trial of vaginal delivery in the scarred uterus].
We present a retrospective study of 1235 deliveries in scarred uterus. The aim of this study is to analyse the materno-fetal mortality and morbidity after caesarean section and a trial vaginal delivery. Uterine challenge has been tried is 578 cases with success in 12.14%. The global rate of real uterine rupture is 1.3% and of scare opening is 3.16%. The trial vaginal birth was complicated by uterine rupture in 5.9% versus 2.89% in planned caesarean section. (P = 0.00967). The length of hospitalization, the number of blood transfusion and the rate of puerperal infections are lower in the vaginal delivery trial group. The rate of new-born with Apgar < 7 in the 5th minute is in a significative way, lower in the iterative caesarean section group. (2.58% versus 4.67%), (P = 0.048). In the other hand, uterine rupture rate as well as fetal distress rate are higher in case of failure of the vaginal delivery. Maternal and fetal complications are rare and seem to be more frequent in case of failure of the uterine challenge. Accurate analysis of different obstetrical situations is necessary in order to predict the success or the failure of the vaginal delivery trial. It may lessen the maternal and fetal morbidity.
Ben
Aissia Nizar
AN
Service de gynécologie Obstétrique CHU Mongi Slim la Marsa.
Sadfi
Afif
A
Gara
Faouzi
F
D000328:Adult; D002921:Cicatrix; D005260:Female; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D008428:Maternal Mortality; D009017:Morbidity; D011247:Pregnancy; D011256:Pregnancy Outcome; D011379:Prognosis; D011645:Puerperal Infection / Q000209:etiology; D014597:Uterine Rupture / Q000209:etiology; D014599:Uterus / Q000473:pathology*; D016064:Vaginal Birth after Cesarean / Q000009:adverse effects*