A CLINACAL AUDIT ON THE OUTCOME OF VBAC IN A PALESTINIAN HOSPITAL (HGH) FACULTY OF MEDICINE ALQUDS UNIVERSITY SUPERVISED BY: DR.FATIMA SHARABATI OBS & GYN DEP. AT HGH DONE BY: YAHYA A. KHATEEB LOTFI M. SROOR MOATH M. MOUSA RECS ( Repeat Elective Cesarean Section )
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A CLINACAL AUDIT
ON THE OUTCOME OF VBAC
IN A PALESTINIAN HOSPITAL
(HGH)
FACULTY OF MEDICINE
ALQUDS UNIVERSITY
SUPERVISED BY:
DR.FATIMA SHARABATI
OBS & GYN DEP. AT HGH
DONE BY:
YAHYA A. KHATEEB
LOTFI M. SROOR
MOATH M. MOUSA
RECS ( Repeat
Elective
Cesarean
Section )
METHOD
• Retrospective study done at Obs & Gyn Department at
Hebron Governmental Hospital, under supervision of
Dr.Fatima Sharabati, with approval of Dr. Hisham Amro,
Head of the department.
• Study done by clinical review of patients’ medical records
between 1st Nov 2015 until 18th Nov 2015.
With follow up for any reported medical complications on
both Mothers and Babies., in the first month post partum.
No. of cases Cases
excluded No. of previous 1
CS Elective
CS VBAC
tried Success
Failure
(urgent CS)
298 263 35 7 28 22 6
100% 88.3% 11.7% 20.0% 80.0% 78.6% 21.4%
Cases excluded 88.26%
Elective CS 2.35%
VBAC tried 9.40%
Cases of the study
Success 78.57%
Failure (urgent CS)
21.43%
Results of VBAC
0
1
2
3
4
5
6
7
8
15-19 20-24
25-29 30-34
35-39 40-44
AGE DISTRIBUTION
No. of success
No of cases included
Age No. of success No of cases included
15-19 1 1
20-24 3 7
25-29 6 8
30-34 5 7
35-39 5 7
40-44 2 5
No. of parity Success VBAC Failure of VBAC Elective CS
1 4 3 4
2 4 1 0
3 2 1 2
4 4 0 0
5 5 0 0
6 1 0 0
7 2 1 0
9 0 0 1
1 2 3 4 5 6 7
4 4
2
4
5
1
2
3
1 1
0 0 0
1
No
. o
f c
as
es
Parity
Parity vs. Success
Success VBAC Failure of VBAC
No. of NSVD before CS Success Failure
0 9 4
1 or more 13 2
1 2 1
2 4 0
3 3 0
4 1 0
5 3 0
6 0 1
Success 87%
Failure 13%
NSVD before CS
Success 69%
Failure 31%
No NSVD before CS VS.
VS.
( Para 1 , Previous 1 )
Success 93%
Failure 7%
With Hx of VBAC
Success 64%
Failure 36%
Without Hx of VBAC VS.
VS.
No of previous VBAC Success Failure
0 9 5
1 or more 13 1
1 10 0
2 1 1
3 1 0
4 1 0
0
1
2
3
4
5
6
7
26 27 31 32 37 38 39 40 41 42
Gestationl Age
GESTATIONAL AGE VS. SUCCESS
Success
Failure
WEIGHT OF BABY
Weight of baby Success Failure Elective
500 - 999 1 0 0
1000 - 1499 1 0 0
1500 - 1999 2 0 0
2000 - 2499 0 1 4
2500 - 2999 2 1 0
3000 - 3499 6 4 3
3500 - 3999 8 0 0
4000 - 4499 2 0 0
0 1 2 3 4 5 6 7 8
500 - 999
1000 - 1499
1500 - 1999
2000 - 2499
2500 - 2999
3000 - 3499
3500 - 3999
4000 - 4499
Weight of baby VS. Success
Failure
Success
INDICATIONS OF
ELECTIVE REPEAT OF CS
CS Type Indication Cases
Urgent (Failed VBAC) Pathological Trace 6
Breech 2
Low laying placenta 1
Placenta previa centralis 1
Previous 4th degree tear 1
IVF Twin 1
IVF Infertality 1
Elective
CS Type Indication Cases
Urgent (Failed VBAC) Pathological Trace 6
Breech 2
Low laying placenta 1
Placenta previa centralis 1
Previous 4th degree tear 1
IVF Twin 1
IVF Infertality 1
Elective
Maternal Request
(IVF Twin , IVF Infertility) 2
INDICATIONS OF
URGENT CS
(FAILED VBAC)
CS Type Indication Cases
Urgent (Failed VBAC) Pathological Trace 6
Breech 2
Low laying placenta 1
Placenta previa centralis 1
Previous 4th degree tear 1
IVF Twin 1
IVF Infertality 1
Elective
DISCUSSION
Results of our study where compared with VBAC Guidelines -2015,
prepared by National Institute for health and Care Excellence (NICE)
for Royal College of Obs & Gyn in UK.
DISCUSSION
• The success rate of VBAC in our study was : 78.6% , more
than the overall chance of successful planned VBAC
according to the Royal college guidelines, which was (72-
75%).
• Increased Parity number was associated with decrease
failure rates.
DISCUSSION
• High success rates in those had History of previous
normal delivery before their first CS (87%), and lower
success rate (69%) in those without any history of
previous normal delivery before the CS.
• High success rates in those had History of previous VBAV
(normal delivery) after their first CS (93%), and lower
success rate (64%) in those with no history of previous
VBAV after the CS (this is the first VBAC).
DISCUSSION
• The term babies have more chance of successful VBAC,
with the highest success rate was at gestational age
between 39 and 39+6 weeks
• Although it was suspected to have more failure rates with
increase weights of babies, but in our study there was 10
cases included with weights of 3500-4500 , with success
rate of 100% and no reported maternal nor newborns
medical complications in the first month post partum.
DISCUSSION
• Indications of Elective repeat of CS included: Breech