MODE OF DELIVERY FOLLOWING PREVIOUS SINGLE CESAREAN SECTION

Abstract

One of the most controversial issues in obstetric practices in 1980 has been the increased incidence of cesarean deliveries. In presentation in 1916 to Eastern Medical Society of New York City, Dr. Edwin Gragin made his famous statement once a cesarean always a cesarean (Current, 1997). This dictum dates back to era when most cesarean sections involved classic uterine incision and when antibiotics and transfusions were unknown. Now, due to changes in the type of uterine incision being mostly lower segment transverse, combined with advances in technology, which allows continuous and accurate monitoring of the mother and the fetus, it is widely accepted that an attempt at vaginal delivery should be made unless there is other indication for bdominal delivery. Patients with previous cesarean section now represents a relatively large proportion of obstetric population, in U.S.A. more than 6% of all obstetric population had at least one cesarean section, and no other single indication excised that of previous section as an indication for repeat the surgery. A recent American College of Obstetricians & Gynaecologists Committee recommended that the concept of routine repeated cesarean birth should be replaced by a specific indication for a subsequent abdominal delivery and in the absence of a contraindication, a woman with one previous cesarean delivery with low transverse incision should be counseled and encouraged to attempt labour in her current pregnancy. In Sweden, the incidence of cesarean birth rate has increased more than ten folds over the past three decades. This trend of the increase in the cesarean section rate is more apparent in the developed countries than in the third world countries. The primary reason for this increase has been the increased safety of the operation due to better anesthesia, antibiotic and blood products plus the obstetrician's strong desire to deliver a child without damage. Philipson et al (1985) stated that four diagnostic categories were found to be responsible for the majority of cesarean rate increase. Dystocia was responsible for 30%. Repeated cesarean accounted for 25 - 30%. Breech presentation and foetal distress, each accounted for I 0 - I 5% of the remaining known causes for this increase. Delivery by cesarean section is associated with greater maternal mortality and morbidity as well as an increased cost for health care system.