Impact of FLAMM scoring on cesarean section rate in previous one lower segment cesarean section patient

Abstract

INTRODUCTION As globally the trend of cesarean section rate increases, this influences the rate of repeat cesarean section. So the American College of Obstetricians and Gynecologists and the American Academy of Family Physicians recommend that pregnant women with a single previous cesarean delivery and a low-transverse incision be offered a trial of labor. 1,2 In July 2010, The American College of Obstetricians and Gynecologists (ACOG) similarly revised their own guidelines, "Attempting a vaginal birth after cesarean (VBAC) is a safe and appropriate choice for most women who have had a prior cesarean delivery, including for some women who have had two previous cesareans." 3,4 VBAC is an acceptable approach for reducing cesarean delivery. 5 Although the rate of vaginal birth after cesarean delivery (VBAC) had decreased from 28 percent in 1996 to only 9.2 percent of all deliveries in 2004. 6,7 The decline had been partially due to the small but measurable risk of uterine rupture which was approximately 0.2-0.5% with ABSTRACT Background: The aim of this study was to evaluate the impact of Flamm scoring for Successful VBAC (vaginal birth after cesarean) and Failed TOLAC (Emergency cesarean section) in case of previous one lower segment cesarean delivery. Methods: This is prospective observation study. Out of 150, 111 patients gave consent for TOLAC. 111 patients with previous one caesarean section with gestational weeks between 37 to 40 weeks with spontaneous onset of labour admitted in labour room of Obstetrics and Gynecology Department in Sola Civil Hospital over a period of 1 year from April 2014 to April 2015. Results: In the present study, 111 (74%) patients had undergone TOLAC trial. Out of 111, 77(69.36%) patients had successful VBAC whereas 34 (30.63%) had emergency cesarean. Among the successful VBAC, 7 patients had assisted vaginal delivery to cut short the second stage in prolonged labour. 26% patients refused to give consent for TOLAC from total number of patients in this study. Mean FLAMM score for Successful VBAC was 5.35 (95% CI, 3.9 to 6.7) compared to Failed TOLAC (EME CS) was 3.62 (95% CI, 3.27 to 4.57) Chances of success of TOLAC was increased with increasing FLAMM score according to this study. Conclusions: Application of FLAMM scoring gives fare judgment of successful vaginal birth in TOLAC. So FLAMM scoring can be applied in each previous one lower segment cesarean section patient undergoing TOLAC without increasing morbidity. Practice of protocol of applying FLAMM score and monitoring by partogram will reduce the rate of cesarean section in previous one lower segment cesarean section patient.