Spontaneous vaginal birth after multiple previous caesarean sections: A case report and literature review

Nnamdi Vitalis Udeozor, Ifeanyi Johnson Onyekpa, Emmanuel Ikechukwu Okolie *, Chidimma Akudo Omeke, Joseph Tochukwu Enebe, Boniface Uwaezuoke Odugu, Sylvester Onuegbunam Nweze, Chukwuka Chude Eze, Emmanuel Godwin Ugochukwu, Ugochukwu Daniel Umekwe, Ogechukwu Crescent Abugu, Munachimso Stephanie Nwafor and Chimdalu Ubaka Omeje

Department of Obstetrics and Gynecology, Enugu State University of Science & Technology (ESUT) Teaching Hospital, Enugu, Nigeria.
 
Case Report
World Journal of Advanced Pharmaceutical and Medical Research, 2024, 07(01), 009–013
Article DOI: 10.53346/wjapmr.2024.7.1.0039
 
Publication history: 
Received on 17 May 2024; revised on 27 July 2024; accepted on 30 July 2024
 
Abstract: 
Background: Vaginal birth after caesarean section (VBAC) is increasingly recognized as a safe and effective option for women with a history of Caesarean deliveries. However, limited attention has been given to feasibility and safety of VBAC after multiple caesarean sections.
Case presentation: A 36-year-old woman with a history of four previous Caesarean sections presented in our centre in third stage of labour. Despite counseling for elective Caesarean section, she had a spontaneous vaginal delivery of a live 2.6 kg female neonate in a vehicle en route to the hospital. On arrival, she was stable but had lost about 500ml of blood. Immediate interventions included active management of third stage of labour and assessment for perineal injuries, with subsequent monitoring and blood transfusion. She had a normal postpartum recovery, was discharged after four days, and had a reassuring 6-week post-natal visit, with a referral to family planning.
Conclusion: This case underscores the potential success and safety of vaginal birth after multiple (three or more) Caesarean sections, challenging the notion that a history of repeated C-sections precludes this option. Vaginal birth after CS (VBAC), initially restricted to one previous CS, is now considered in selected cases with two prior abdominal deliveries. However, the acceptance of VBAC after three or more CS remains limited despite available evidences indicating comparable success rates and maternal risks for VBAC after multiple CS when compared to VBAC after one prior CS or elective repeat CS.

 

Keywords: 
VBAC; Multiple Caesarean sections; Caesarean section rate; Vaginal birth
 
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