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. 2017 Aug 25;17(1):272.
doi: 10.1186/s12884-017-1467-5.

Maternal and perinatal outcome after previous caesarean section in rural Rwanda

Richard Kalisa  1   2 , Stephen Rulisa  3 , Jos van Roosmalen  4   5 , Thomas van den Akker  5
Affiliations

Maternal and perinatal outcome after previous caesarean section in rural Rwanda

Richard Kalisa et al. BMC Pregnancy Childbirth. .

Abstract

Background: Offering a trial of labor (ToL) after previous caesarean section (CS) is an important strategy to reduce short- and long-term morbidity associated with repeated CS. We compared maternal and perinatal outcomes between ToL and elective repeat caesarean section (ERCS) at a district hospital in rural Rwanda.

Methods: Audit of women's records with one prior CS who delivered at Ruhengeri district hospital in Rwanda between June 2013 and December 2014.

Results: Out of 4131 women who came for delivery, 435 (11%) had scarred uteri. ToL, which often started at home or at health centers without appropriate counseling, occurred in 297/435 women (68.3%), while 138 women (31.7%) delivered by ERCS. ToL was successful in 134/297 (45.1%) women. There were no maternal deaths. Twenty-eight out of all 435 women with a scarred uterus (6.4%) sustained severe acute maternal morbidity (puerperal sepsis, postpartum hemorrhage, uterine rupture), which was higher in women with ToL (n = 23, 7.7%) compared with women who had an ERCS (n = 5, 3.6%): adjusted odds ration (aOR) 1.4 (95% CI 1.2-5.4). There was no difference in neonatal admissions between women who underwent ToL (n = 64/297; 21.5%) and those who delivered by ERCS (n = 35/138; 25.4%: aOR 0.8; CI 0.5-1.6). The majority of admissions were due to perinatal asphyxia that occurred more often in infants whose mothers underwent ToL (n = 40, 13.4%) compared to those who delivered by ERCS (n = 15, 10.9%: aOR 1.9; CI 1.6-3.6). Perinatal mortality was similar among infants whose mothers had ToL (n = 8; 27/1000 ToLs) and infants whose mothers underwent ERCS (n = 4; 29/1000 ERCSs).

Conclusions: A considerable proportion of women delivering at a rural Rwandan hospital had scarred uteri. Severe acute maternal morbidity was higher in the ToL group, perinatal mortality did not differ. ToL took place under suboptimal conditions: access for women with scarred uteri into a facility with 24-h surgery should be guaranteed to increase the safety of ToL.

Keywords: Elective repeat caesarean delivery; Maternal morbidity; Sub-Saharan Africa; Trial of labor; Vaginal birth after caesarean section.

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Conflict of interest statement

Ethics approval and consent to participate

Ethical clearance was obtained from the national ethical committee (N°582/RNEC/2013). All data entered into the database were anonymized and could not be traced back to individual participants. The medical director of Ruhengeri hospital gave permission.

Consent for publication

Consent to publish this manuscript from the participants was deemed not applicable since the manuscript does not contain any individual person data.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow chart on mode of deliveries among women underwent trial of Labor and elective repeat caesarean section
See this image and copyright information in PMC

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