The Mode of delivery of grand multiparous with post-cesarean single uterine scar in low resources settings: A retrospective cohort study

Abstract

The Mode of delivery of grand multiparous with post-cesarean single uterine scar in low resources settings: A retrospective cohort study Mve Koh Valèrea,b,*, Belinga Etiennea,c, Elong Phelix Adolphed,e, Toko Fokam Bricee, Pierre Marie Tebeua a Faculty of Medicine and Biomedical Sciences of University of Yaoundé, Yaoundé, Cameroon b University Teaching Hospital of Yaoundé, Yaoundé, Cameroon c Centre Hospitalier de Recherche et d’Application en Chirurgie Endoscopique et Reproduction Humaine (CHRACERH) Yaoundé Cameroon d Faculty of Health Sciences of the University of Buea, Buea, Cameroon e Buea Regional Hospital, Buea, Cameroon A R T I C L E I N F O Article history: Received 1 February 2019 Received in revised form 17 June 2019 Accepted 24 June 2019 Available online 5 July 2019 Keywords: Grand multiparity Scar uterus Cameroon A B S T R A C T The prevalence of post-caesarean scar uterus, the most important risk factor of uterine rupture is increasing globally. Grand multiparity can also increase the risk of uterine rupture. The issue of grand multiparous with single post caesarean scar is poorly investigated. Objectives: The purpose of this study was to assess the factors associated with the mode of delivery of grand multiparous with post caesarean single uterine scar in low resources settings. Patients and Method: It was a retrospective cohort study conducted from the 1st January to the 31st of May 2016, in three university teaching hospitals of the university of Yaoundé I in Cameroon. Grand multiparous (GMP) defined as parity 5 with single post-caesarean lower segment uterine scar admitted at a gestational age of 37 completed weeks and above were compared to grand multiparous without scar uterus at term. GMP with unknown scar were excluded. The mode of delivery and materno-fetal and neonatal outcome were investigated. Results: We included 33 GMP with single lower segment uterine scar and 120 GMP without uterine scar. Induction of labor and acute fetal distress were not related to having a scar or not in grand GMP, but augmentation of labor was less likely to be conducted in case of GMP with scar uterus(p = 0.08). The frequency of vaginal delivery was 75.8 and 87.5% in grand multiparous with and without uterine scar respectively (OR 0.17–1.16; P = 0.085), with one case of instrumental delivery in scarless group. However, single scar multiparity status increased by 2.42 folds the risk of delivery by caesarian section (P = 0.066). Cephalo-pelvic disproportion increased the indication of caesarian section by 12-fold in the GMP with scar group (p = 0.031), but mechanical dystocia related indications (CPD, macrosomia,) were present in only 4 cases out of 8 caesarian sections in the exposed group. The Apgar score at the fifth minute was better in the GMP with scar group. (p = 0.037). Conclusion: Grand multiparous with single post-cesarean uterine scar should be given a chance of vaginal delivery in the absence added feto-maternal morbidity.