title: Is vaginal delivery safe after previous lower segment caesarean section in developing country?
abstract: BACKGROUND
  To analyse the mode of delivery in trial of labour (TOL), incidence of successful vaginal deliveries and indications of repeat caesarean section (CS).
  
  
  METHODS
  Prospective selective study. Study population consisted of 367 pregnant women with previous one lower segment caesarean section (LSCS) in reproductive age group. These were grouped in to three groups, Group 1 (n = 239): Women, who were elected for repeat CS without a TOL. Group 2 (n = 76): Women, who were given TOL and delivered vaginally. Group 3 (n = 52): Women, who were given a TOL but due to failed trial, had to be taken for emergency repeat section. The maternal and foetal outcome was studied in all the groups.
  The data was entered in the Microsoft excel worksheet, values expressed as mean ± SD. Chi-square test was done to compare the categorical variables among the groups. ANOVA (one-way analysis of variance) was done to compare the baseline characteristics of patients and time to delivery among the groups.
  
  
  RESULTS
  Out of 128 women who were given TOL, 76 (59.37%) vaginal birth after caesarean (VBAC) occurred, out of which 40 (52.63%) had spontaneous vaginal deliveries without augmentation of labour and 36 (47.36%) subjects had augmentation of labour with artificial rupture of membranes (ARMs) and oxytocin. A total of 52 women (40.62%) underwent emergency LSCS.
  
  
  CONCLUSIONS
  Proper selection and counselling about clinically significant risks, women can be given TOL with careful monitoring and taken for emergency LSCS on minimal indication is the best answer to management of previous one CS in labour.
authors.affiliation: Department of Gynaecology and Obstetrics, Post Graduate Institute Of Medical Sciences and Research Employees State Insurance, Basaidarapur, New Delhi, India.
authors.forename: Pratiksha
authors.initials: P
authors.lastname: Gupta
authors.affiliation: Department of Gynaecology and Obstetrics, Post Graduate Institute Of Medical Sciences and Research Employees State Insurance, Basaidarapur, New Delhi, India.
authors.forename: Ishrat
authors.initials: I
authors.lastname: Jahan
authors.affiliation: Department of Gynaecology and Obstetrics, Post Graduate Institute Of Medical Sciences and Research Employees State Insurance, Basaidarapur, New Delhi, India.
authors.forename: Gelabhai R
authors.initials: GR
authors.lastname: Jograjiya
keywords: Caesarian section; safe; trial of labour; vaginal birth after caesarean section