EFFECTIVENESS OF A STRUCTURED VBAC CHECK-LIST IN IMPROVING CARE AND SUCCESS OF VBAC AMONG PREGNANT WOMEN WITH ONE PREVIOUS CAESAREAN SECTION

*Jombo Se, Okome Gbo, Momoh Mo, Isabu P., Eifediyi Ra, Onwusulu Dn, Nwali Sa and Ilikannu So

ABSTRACT

Objective: This study evaluated the effectiveness of a structured VBAC checklist in improving care and success of VBAC among pregnant women with one previous caesarean section. Materials and Methods: This study was a comparative cohort study that was carried out in two phases. The first phase (Group A) was a prospective study of all women with one previous caesarean section booking for antenatal care who meet the inclusion criterion with the routine use of a structured VBAC checklist. While the second phase (Group B) was a retrospective study of cases of booked women with one previous caesarean section managed within the immediate past two- year period in the hospital just before the commencement of this study, which were selected by systematic random sampling technique. Sixty participants were recruited for group A. Data was collected, computed and analyzed with the IBM Statistical Package for Social Sciences (SPSS) -20. Statistical comparison was done using Chi-Square (X2). The level of significance was accepted when P-value was equal to or less than 0.05 and confidence interval of 95 %. Results: The mean age for group A and B were 33.17±4.64 and 32.92±3.41 years respectively. The prevalence of one previous caesarean section among pregnant women was 16.9 %. Fifty seven (95%) of women in group A and 44(73.3%) in group B, had trial of vaginal delivery after caesarean section. The success rate of VBAC were 54.4% and 40.9% in group A and B respectively(x2=1.806, P=0.179; OR=1.79 (0.77, 3.81). Failed VBAC were comparable in both groups with poor progress and fetal distress being the commonest indication for repeat caesarean section. Maternal and fetal outcomes were comparable in both groups with blood transfusion as the commonest maternal morbidity and birth asphyxia as the commonest fetal complication. Conclusion: The use of a structured VBAC checklist improves success rate of trial of vaginal delivery after one previous caesarean section by 1.33 folds. A structured VBAC checklist should be an essential tool to appropriately select eligible patient and offer women education and counseling for an informed decision.

Keywords: Checklist, One previous c/s, vaginal birth after caesarean section.