Pregnancy and Childbirth in Women with Prior Cesarean Section

Background: The rising rate of cesarean section has led to an increasing number of pregnancies complicated by a previous uterine scar. Management of such pregnancies requires careful decision-making between Trial of Labour After Cesarean (TOLAC) and Elective Repeat Cesarean Section (ERCS) to optimise maternal and neonatal outcomes.

Objective: To evaluate pregnancy outcomes, mode of delivery, and associated maternal and neonatal complications in women with a prior cesarean section.

Methods: This prospective observational study was conducted over a period of one year at GMERS Sola Civil Hospital. A total of 1,430 pregnant women with a history of one or more previous cesarean sections and gestational age ≥28 weeks were included. Demographic data, obstetric history, mode of delivery, maternal complications, and neonatal outcomes were recorded and analysed using descriptive statistics and the Chi-square test, with p<0.05 considered statistically significant.

Results: Most women (78%) had one previous cesarean section. Repeat cesarean section was the predominant mode of delivery (68%), while 32% achieved successful vaginal birth after cesarean (VBAC). The most common indication for emergency repeat cesarean was fetal distress. Uterine rupture occurred in 0.5% of cases. Postpartum haemorrhage was observed in 6%, and 8% required blood transfusion. Neonatal outcomes were generally favourable, with 13% NICU admissions and 1.3% perinatal mortality.

Conclusion: Pregnancy after a previous cesarean section is associated with increased operative delivery rates but acceptable maternal and neonatal outcomes when managed in a well-equipped tertiary care centre. Careful patient selection, vigilant monitoring, and readiness for emergency intervention are essential for safe TOLAC. Reducing primary cesarean rates and promoting evidence-based VBAC practices are important to minimise long-term maternal morbidity