According to a population-based cross sectional study in Madras, India [ 4], caesarean section rates in the public, charitable and private sectors were 20%, 38%and47%7% respectively, and the total population caesarean section rate was 32.6% with a primary caesarean section rate of 25%.
9 22 Reasons for the increase in caesarean section rates in the developed world are complex, and may include fear of litigation, 23 maternal request, 24 previous caesarean section 25 and reduction in vaginal birth after a primary caesarean section.
The total number of women who gave birth from 1998-2008 was 965,702, including 151,516 who had a primary caesarean section (61.9%) and 93,306 who had a repeat caesarean section (38.1%).
MacDorman et al 23 suggested that the rapid increase in the caesarean section rate from 1996 onward in the USA reflected two current trends: an increase in the primary caesarean section rate and a steep decline in vaginal birth after a primary caesarean section.
These are means by which a primary Caesarean section could be avoided.
This retrospective population based cohort study included patients who delivered after a primary cesarean section (n = 9983).
Furthermore, women with vaginal birth after a primary caesarean section (VBAC) have shown to be at higher risk for OASIS than both nulliparous and other parous women [ 34].
In case of breech presentation, a primary caesarean section is allowed based on the preference of both the patient and the gynaecologist.
Additionally, the hospital rate of vaginal delivery for the birth following a primary caesarean section for breech presentation was used as a proxy for hospital predisposition to carry out a vaginal birth after caesarean (referred to as 'hospital propensity towards VBAC').
In comparison to all patients with who had a primary cesarean section, patients who had placenta previa and delivered preterm had an independent increased risk for recurrent preterm birth [OR of 3.6 (95% CI 1.5-8.5 1.5-8.5
The increased rate of OASIS among women undergoing VBAC may be explained by fetopelvic disproportion leading to a primary caesarean section possibly predisposing to OASIS at first vaginal delivery [ 25, 38].
