Trial of labor in women with two previous caesarian sections: a challenge

IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL
Ima Indirayani, Hilwah Nora, Rusnaidi, Cut Meurah Yenni, F. Zahara, Dara Meutia Ayu Febrina
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Abstract

Introduction: A trial of labor after a cesarean (TOLAC) section is a maternal choice with previous caesarian section. However, for those with 2 previous scars, there are pros and cons to allowing the patient for vaginal birth after caesarian section (VBAC) in view of increasing complications. The incidence of SC in Indonesia has been increasing over the year. In addition, several studies have shown an increased risk of problems in subsequent pregnancies in mothers with a history of cesarean section. Thus VBAC in 2 previous scars becomes a alternative choice for a certain patient. Case Illustration: We reported 3 cases of TOLAC; Three of the cases were planned for vaginal birth after caesarian section (VBAC) since prenatal periode Case 1: A 30-year-old woman, G3P2, 39 weeks with two times previous cesarean section. Cardiotocography was normal. The patient was closely monitoring the signs of uterine rupture during labor, and after 7 hours, she had a successful VBAC without complication. Born female baby with body weight 4000 with a good, mother and baby were in good condition. Case 2: A 38-year-old woman, G6P4A1, 41 weeks pregnant with two previous vaginal deliveries and had two previous CS before the current pregnancy. The patient was closely monitored of vital signs and signs of uterine rupture. Cardiotocography is normal. After 8 hours later, she had a successful VBAC without complication, born a male baby with a body weight of 3500gr, with good APGAR score. Case 3: A 35-year-old woman, G3P2A0, had two previous CS admitted at 39 in the latent phase of labor with a cervical dilatation of 2 cm. The labor progressed to second stage after 9 hours. After a hour attempted to conduct delivery, the fetus was still not delivered. Catheterization was performed and found haematuria and proceded with emergency CS due to suspect a uterine rupture. Intraoperatively, the uterine rupture was noted at lower anterior of uterine corpus size 2x1 cm and a repair was performed Conclusion: VBAC can be considered in patients with two previous c-sections with after proper selection, close monitoring and adequate counseling. Prenatal care is a concern for pregnant women to prevent complications and reduce maternal and fetal morbidity and mortality. The VBAC decision returned to personalization and adequate assessment and counseling are mandatory.
有过两次剖宫产的妇女的分娩试验:一个挑战
简介:剖宫产后试产(TOLAC)是一个产妇选择与以前的剖腹产。然而,对于那些以前有2个疤痕的人来说,考虑到并发症的增加,允许剖腹产后顺产(VBAC)有利有弊。一年来,印度尼西亚的SC发病率一直在增加。此外,几项研究表明,有剖宫产史的母亲在随后的怀孕中出现问题的风险增加。因此,VBAC在2个以前的疤痕成为一个替代的选择,为某些患者。病例说明:我们报告了3例TOLAC;病例1:30岁妇女,G3P2, 39周,既往两次剖宫产。心脏造影正常。患者在分娩过程中密切监测子宫破裂的迹象,7小时后,她成功进行了VBAC,无并发症。出生的女婴体重4000斤,身体状况良好,母婴健康状况良好。病例2:一名38岁的女性,G6P4A1,怀孕41周,两次阴道分娩,在本次妊娠前有两次CS。密切监测患者的生命体征和子宫破裂的迹象。心脏造影正常。8小时后VBAC成功,无并发症,出生男婴,体重3500gr, APGAR评分良好。病例3:一名35岁的女性,G3P2A0,在分娩潜伏期的39岁时曾有两次宫颈扩张2厘米。9小时后产程进入第二阶段。经过一个小时的分娩尝试,胎儿仍然没有出生。插管后发现血尿,并因怀疑子宫破裂进行紧急CS治疗。术中发现子宫下前段子宫破裂,大小为2x1 cm,并行修复术。结论:术前两次剖腹产患者,经适当选择、密切监测和充分咨询后,可考虑行VBAC。产前护理是孕妇关注的问题,旨在预防并发症,降低孕产妇和胎儿的发病率和死亡率。VBAC的决定回归到个性化和充分的评估和咨询是强制性的。
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来源期刊
Bali Medical Journal
Bali Medical Journal MEDICINE, GENERAL & INTERNAL-
自引率
50.00%
发文量
8
审稿时长
3 weeks
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