الفهرس 
CESAREAN SECTIONOnly 14 pages are availabe for public view
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Abstract
There has an increase in cesarean section rate over the past 20 years, which is not uniform but associated with wide variation between and within countries.
Many factors are responsible for this increase namely increased safety of the operation due to better aneasthesia, antibiotics and blood products.
But the incidence of cesarean section started to decrease since 1990 due to increased vaginal birth after prior cesarean section and to a lesser extent as a small decrease in the primary cesarean rate this change due to increased concern about the safety of labor in women with prior cesarean section.
The women who had cesarean section due to breech presentation, fetal distress, pregnancy induced hypertension, antepatum hemorrhage and multiple gestation, these indications are often non-recurring and many of those women when become pregnant again there is no contraindications for attempting vaginal delivery.
Most recent reports support the safety of VBAC in women with one cesarean as well as its cost effectiveness for the patients, her family and for heath care system, this make VBAC rates in a steady increase.
So it is better to allow a trial of labor for selected patients because vaginal delivery not only is as safe as cesarean section but is in fact the preferable method of management in carefully selected patients.
This present study was conducted at Ain-Shams university maternity hospital and El-Galaa maternity hospital in the period from the first of January 2012 to the end of septemper 2012.
The patients in both hospitals were classified into patients who had induction of labour by prostagladinE2 and patients who went into spontaneous labour, those patients were further classified into who had a successful vaginal birth after cesarean section and repeated cesarean section
from the results obtained in this study we found many factors which affected success rate vaginal birth of cesarean section (VBAC).
There was increased success rate of VBAC in both groups with presence of a history of previous successful vaginal delivery especially if it was after previous cesarean section.
Success rate of VBAC increased with increasing maternal parity in both groups because those patients of high parity had previous vaginal delivery.
Success rate of VBAC increased when fetal weight was less than 4000 gm (there was no successful TOL with fetal weight > 4000 gm).
Fetal gestational age affected success rate of TOL especially in the group who offered induction of labour (there was no successful TOL with post dates > 41 wks).
As regard maternal complication there was one case of rupture uterus which was repaired and patient recived 2 units of blood post operative and fetal condition is good.
No maternal and perinatal mortalities were detected among studied patients.
Trial of scar after previous caesarean delivery is safe for patients who are managed in tertiary care centers and in those hospitals where intensive surveillance, expertise and facilities for emergency caesarean section and exploratory laparotomies are available.