Spontaneous Vaginal Delivery after Three Previous Caesarean Sections

Abstract

Women with one previous caesarean section have 0.05% risk of uterine rupture, with two caesarean sections the risk increase to 1.36%. We could not find data on the risk of uterine rupture after three caesarean sections. Elective caesarean section is therefore offered to these women by their clinical professionals to eliminate the risk. However, we report a case of spontaneous vaginal delivery with an intact uterine scar in a woman with a previous three caesarean sections to show the possibility of vaginal birth in patients with repeated caesarean section. A 32-year-old female in her 4th pregnancy with previous three caesarean section 1st two emergencies and 3rd elective (Gravida 4, para 3) presented to the delivery suite in spontaneous labour at 39 weeks and 3 days with vaginal bleeding. Emergency call gone off and patient was transferred immediately to theatre, during transfer she pushed down while she was on the wheel chair and the baby head found to be delivered vaginally. A live healthy baby girl weighing 2590 g was delivered. The patient had Postpartum bleeding of 500 ml and 2nd degree perineal and labial tears; the patient was discharged home fit and well on day one postpartum. Repeated caesarean section increases maternal mortality and morbidity. Vaginal birth after repeated previous caesarean sections could still be an option in selected cases as safe vaginal delivery has been reported.