Background
Methods
Study sites
Study design
Data collection
Statistical analysis
Ethics
Results
Socio-demographic characteristics
Parameters |
N (%) |
---|---|
Woman’s age (years) | |
20-24 | 25 (12.4%) |
25-29 | 64 (31.7%) |
30-34 | 77 (38.1%) |
> 35 | 36 (17.8%) |
Educational level | |
Primary | 38 (18.8%) |
Secondary | 92 (45.6%) |
University | 72 (35.6%) |
Marital Status | |
Married | 190 (94.0%) |
Single | 10 (5.0%) |
Separated | 2 (1.0%) |
Occupation | |
Employed | 49 (24.3%) |
Business /self employed | 92 (45.5%) |
Student | 2 (1%) |
Housewive | 59 (29.2%) |
Parameters |
N (%) |
---|---|
Woman’s parity | |
1 | 153 (75.7%) |
2-3 | 45 (22.3%) |
> 3 | 4 (2%) |
Outcome of previous caesarean delivery | |
live infant | 166 (82.1%) |
Live infant in distress | 4 (2%) |
Premature baby | 1 (0.5%) |
Still birth | 11 (5.4%) |
Neonatal death | 10 (5%) |
Infant death | 6 (3%) |
Not documented | 4 (2%) |
Medical or obstetrical complications after the previous c/s according to the participant’s interview (n = 32) | |
Bleeding (PPH) | 3 (7.9%) |
Eclampsia | 8 (21.1%) |
Maternal infections | 8 (21.1%) |
Death of the baby(neonatal death) | 15 (39.5%) |
Burst abdomen | 3 (7.9%) |
Post partum psychosis | 1 (2.6%) |
Women’s family planning method choice following the current delivery | |
Bilateral Tubal Ligation | 12 (5.9%) |
Natural | 1 (0.5%) |
Pills | 6 (3%) |
Injections | 2 (1%) |
Not yet decided | 181 (89.6%) |
Women’s preferred mode of delivery before attending KNH | |
Trial of labour | 86 (42.6%) |
Elective repeat c/s | 95 (47.0%) |
Not sure | 17 (8.4%) |
Any | 4 (2.0%) |
Antenatal clinical assessment
Parameters |
N (%) |
---|---|
Medical or obstetrical complication documented during ANC | |
Preeclampsia | 8 (4%) |
Diabetes | 2 (1%) |
Anemia | 1 (0.5%) |
HIV-positive | 7 (3.4%) |
Placenta praevia | 2 (1%) |
Malpresentation | 5 (2.5%) |
Fibroids | 5 (2.5%) |
No complication documented/indicated | 172 (85.1%) |
Documented reasons for the previous caesarean delivery | |
CPD/big baby | 31 (15.3%) |
Malpresentation | 15 (7.4%) |
APH | 4 (2%) |
Failed induction | 18 (8.9%) |
Prolonged labour | 32 (15.8%) |
Non reassuring foetal distress | 55 (27.2%) |
Not documented | 47 (23.3%) |
Medical or obstetrical complication postpartum documented after the previous caesarean delivery | |
Infections | 2 (1%) |
Preeclampsia | 2 (1%) |
Not documented | 198 (98%) |
Estimated foetal birth weight (Kg) clinically or by U/S documented at the time of the decision of mode of delivery | |
< 3.5 | 15 (7.4%) |
≥ 3.5 | 4 (2%) |
Not documented | 183 (90.6%) |
Consent form signed and documented in the file at the time of decision for mode of delivery | |
Yes (Women admitted for ERCD from ANC) | 23 (11.4%) |
Booked in elective diary | 92 (45.8%) |
Not documented | 86 (42.8%) |
Participants’ knowledge on risks and benefits of both modes of delivery.
Parameters |
N (%) |
---|---|
Women’s knowledge on risks associated with repeat C/S than TOLAC (n = 163) | |
Increased blood loss | 124 (28.4%) |
High risk of infection | 106 (24.3%) |
Complication of anaesthesia | 36 (8.3%) |
Uterine scar rupture in case of big baby | 10 (2.3%) |
Injury to organs | 5 (1.1%) |
Recovery is longer | 140 (32.2%) |
Limb numbness | 15 (3.4%) |
Women’s knowledge on risks associated with TOLAC than ERCD (n = 155) | |
Uterine scar rupture resulting in emergency C/S | 54 (20.8%) |
Failed trial of labour | 114 (44%) |
Uterine rupture is > with VBAC than repeat C/S | 81 (31.3%) |
Increased blood loss | 5 (1.9%) |
Increased risk of infection | 2 (0.8%) |
Foetal death | 3 (1.2%) |
Women’s knowledge regarding overall chances of success of TOLAC | |
Very high (>50%) | 65 (32.2%) |
Very low (<25%) | 40 (19.8%) |
Don’t know | 97 (48%) |
Women’s knowledge regarding the risks of uterine scar rupture | |
Very low (<1%) but increased with number of c/s | 64 (31.7%) |
Very high (>50%) | 29 (14.4%) |
Don’t know | 109 (53.9%) |
Women’s knowledge on recovery from vaginal delivery against repeat C/S | |
Same | 1 (0.5%) |
Longer for repeat C/S | 166 (82.2%) |
Longer for vaginal delivery | 2 (1%) |
I don’t know | 33 (16.3%) |
Reasons for previous c/s as important factor in determining the chance of successful TOLAC according to the participants | |
Yes | 60 (29.7%) |
No | 30 (14.9%) |
Don’t know | 112 (55.4%) |
Parameters |
N (%) |
---|---|
Number of ANC visits at the time of recruitment | |
< 3 | 60 (29.7%) |
≥ 3 | 142 (70.3%) |
Women informed on available options of mode of delivery | |
Elective repeat c/s | 126 (62.4%) |
Trial of labour | 61 (30.2%) |
None | 15 (7.4%) |
Women counselled on reasons for ERCD against TOLAC (n = 116) | |
Big baby (>3.5 kg) | 21 (18.1%) |
Classical scar | 7 (6%) |
Small pelvis | 15 (12.9%) |
Unavailability of 24 h theatre/blood transfusion/skilled doctors and anaesthetists | 1 (0.9%) |
Mal-presentation/breech presentation | 11 (9.5%) |
Bad obstetric history | 3 (2.6%) |
Choice of BTL | 2 (1.7%) |
Placenta praevia | 21 (18.1%) |
Don’t know | 35 (30.2%) |
Women counselled at discharge after previous C/S on reasons ERCD is recommended in subsequent pregnancy (n = 19) | |
Small pelvis | 13 (68.5%) |
Classical uterine incision | 2 (10.5%) |
High risk of uterine rupture if any VBAC | 2 (10.5%) |
BTL would also be offered | 2 (10.5%) |
Counselling doctor preferred mode of delivery (perception of the participant) | |
None | 44 (21.8%) |
Elective repeat caesarean section | 107 (53%) |
Trial of labour | 51 (25.2%) |
Level of provider at ANC KNH | |
Senior house officer | 174 (86.1%) |
Consultant obstetrician | 28 (13.9%) |
Before KNH-ANC visit (TOLAC) | After ANC visit (TOLAC) | ||
Yes | No | Total | |
Yes | 58 | 28 | 86 (42.6%) |
No | 8 | 108 | 116 |
Total | 66 (32.8%) | 136 | |
Before KNH-ANC visit (ERCD) | After ANC visit (ERCD) | ||
Yes | No | ||
Yes | 91 | 4 | 95 (47%) |
No | 45 | 62 | 107 |
Total | 136 (67.2%) | 66 |
Criteria |
N (%) |
---|---|
Women informed on mode of delivery (available options) (n = 202) | |
TOLAC | 61 (30.2%) |
ERCD | 126 (62.4%) |
Both | 0 |
Women’s knowledge on factors influencing mode of delivery (n = 116) | |
Classical scar as a reason for ERCD | 7 (6%) |
Small pelvis as a reason for ERCD | 15 (12.9%) |
Big baby as a reason for ERCD | 21 (18.1%) |
Current medical or obstetric complications as a reason for ERCD | 30 (25.9%) |
Adequacy of facility for delivery (A 24 h-theater…) | 1 (0.9%) |
Women’s knowledge on success and risk of uterine rupture in TOLAC (n = 202) | |
Patient knowledge on overall chance of TOLAC success | 65 (32.2%) |
Patient knowledge on risk of uterine rapture in TOLAC | 64 (31.7%) |
Reasons of previous caesarean as factor of success for TOLAC | 60 (29.7%) |
Women’s knowledge on risks of ERCD over TOLAC (n = 163) | |
Increased blood loss | 124 (76.1%) |
High risk of infection | 106 (65.0%) |
Complication of anaesthesia | 36 (22.1%) |
Injury to organ | 5 (3.1%) |
Recovery is longer | 140 (85.9%) |
Consent form signed and documented in the patient file (n = 202) | 23 (11.4%) |
Parameters | ERCD
n = 136 | TOLAC
n = 66 |
P-value |
---|---|---|---|
Women’s parity | |||
1 | 104 (76.5%) | 49 (74.2%) | 0.286 |
2-3 | 28 (20.6%) | 17 (25.8%) | |
> 3 | 4 (2.9%) | 0 | |
Number of ANC visits at the time of recruitment | |||
< 3 | 35 (26.3%) | 19 (30.2%) | 0.574 |
≥ 3 | 98 (73.7%) | 44 (69.8%) | |
Counselling doctor preferred mode of delivery | |||
None | 29 (21.3%) | 15 (22.7%) | 0.001 |
Repeat caesarean section | 107 (78.7%) | 0 | |
Vaginal delivery | 0 | 51 (77.3%) | |
Women’s preferred mode of delivery before attending KNH | |||
Trial of labour | 28 (20.6%) | 58 (87.9%) | 0.001 |
Elective repeat c/s | 91 (66.9%) | 4 (6.1%) | |
Not sure | 14 (10.3%) | 3 (4.5%) | |
Any | 3 (2.2%) | 1 (1.5%) | |
Level of provider at ANC KNH | |||
Senior house officer | 123 (90.4%) | 51 (78.5%) | 0.020 |
Consultant | 13 (9.6%) | 14 (21.5%) |
Parameters | ERCD
n = 136 | TOLAC
n = 66 |
P-value |
---|---|---|---|
Women’s knowledge regarding the risks of uterine scar rupture | |||
Very low (<1%) but increased with number of c/s | 17 (26.6%) | 47 (73.4%) | 0.001 |
Very high (>50%) | 27 (93.1%) | 2 (6.9%) | |
Don’t know | 92 (84.4%) | 17 (15.6%) | |
Women’s knowledge regarding overall chances of success of TOLAC | |||
Very high (>50%) | 12 (8.8%) | 53 (80.3%) | 0.001 |
Very low (<25%) | 40 (29.4%) | 0 | |
Don’t know | 84 (61.8%) | 13 (19.7%) | |
Women’s knowledge on recovery from vaginal delivery against repeat C/S | |||
Same | - | 1 (1.5%) | 0.001 |
Longer for repeat C/S | 103 (75.7%) | 63 (95.5%) | |
Longer for a vaginal delivery | 2 (1.5%) | 0 | |
I don’t know | 31 (22.8%) | 2 (3%) | |
Estimated foetal birth weight in Kg clinically or by U/S at the time of the decision of mode of delivery | |||
< 3.5 | 10 (7.4%) | 5 (7.6%) | 0.372 |
≥ 3.5 | 4 (2.9%) | - | |
Not documented | 122 (89.7%) | 61 (92.4%) | |
Women’s awareness on risks associated with repeat C/S than TOLAC | |||
Increased blood loss | 76 (26.6%) | 48 (32%) | 0.482 |
High risk of infection | 65 (22.7%) | 41 (27.3%) | |
Complication of anaesthesia | 26 (9.1%) | 10 (6.8%) | |
Rupture in case of big baby | 8 (2.8%) | 2 (1.3%) | |
Injury to organs | 3 (1%) | 2 (1.3%) | |
Recovery is longer | 96 (33.6%) | 44 (29.3%) | |
Limb numbness | 12 (4.2%) | 3 (2%) |