Vaginal birth after cesarean section in grand multiparous women.

OBJECTIVE

To determine the rate, delivery outcome and safety of attempted vaginal birth after cesarean section (VBAC) in grand multiparous women (para 6 or more).

METHODS

This is a retrospective case-control study, performed at King Abdulaziz university hospital, the charts of 405 grand multiparous women with previous caesarean section were reviewed to determine rate and delivery outcome of attempted VBAC. The outcome of 217 VBAC in grand multiparous women was compared to the outcome of 217 VBAC in multiparous women (para 2-5) during the same period.

RESULTS

The rate of VBAC in grand multiparous women was 53.6%. One hundred-seventy five (80.7%) grand multiparous women were delivered vaginally compared to 170 (78.3%) in multiparous women, this was not statistically significant difference. Sixteen (7.4%) grand multiparous women need labor augmentation with oxytocin, while 34 (16%) in multiparous women, this was statistically significant difference (P value 0.005). The labor duration was 6.4+/-3.5 h in grand multiparous women compared to 9.0+/-4.3 h in multiparous women, and was also statistically significant difference (P value 0.001). The fetal weight, Apgar scores, postpartum hemorrhage, fever and number of hospital days in the two groups, were not statistically significant differences. In the control multiparous women there was one uterine rupture, two uterine dehiscence, and one stillbirth due to placental abruption.

CONCLUSION

VBAC in grand multiparous women is common practice, safe and efficacious. High parity in association with vaginal deliveries is good prognostic factor and also can predict successful VBAC outcome. However, further studies are needed to confirm our findings.