EFFECTS OF SHORT INTER-DELIVERY INTERVAL ON MODE OF DELIVERY IN PREVIOUS ONE CAESAREAN SECTION CASES

Abstract

OBJECTIVE: To determine the effects of short inter delivery interval (IDI) on mode of delivery in patients with immediate previous one caesarean section (C-Section). METHODS: This is a retrospective chart review of 120 patients treated at Khyber Teaching Hospital, Peshawar, Pakistan from December 2017 to December 2019. Patients of previous one C-Section and with gestational age of >37 weeks were included in this study. Outcome variables were mode of delivery whether operative or vaginal delivery, maternal and fetal complications such as scar dehiscence or scar rupture and fetal distress. RESULTS: Mean age of the patients was 28.9±2 years. IDI was <18 months in 35/120 (29.2%) cases, 18-24 months in 54/120(45%) cases and >24 months in 31/120 (25.8%) cases. Out of 120, 102 (85%) patients underwent trial of labour after C-section (TOLAC). TOLAC was successful in 64 (62.7%) cases. Patient who underwent TOLAC with IDI of <18 months, 5/21 (23.8%) patients delivered vaginally and 16/21 (76.2%) patients had emergency C-Section while those with 18-24 months IDI, 38/51 (74.5%) patients delivered and 13/51 (25.4 %) patients had emergency C-Section. Main indications for emergency C-Section were scar tenderness and maternal tachycardia (n=16; 42.10%) and fetal distress (n=11, 28.9%). There were two cases of interauterine deaths. Uterine scar dehiscence was observed in 14.28% and 2.4% in short and normal IDI respectively. CONCLUSION: Patients with short IDI had high C-section and uterine scar dehiscence rate. IDI of >18 months is recommended to avoid the maternal and fetal morbidity and mortality.