Trial of labor in women with two previous caesarian sections: a challenge

Introduction: A trial of labor after a cesarean ( TOLAC) section is an option for mothers who have had a previous caesarian section. However, for those with two previous scars, there are pros and cons to allowing the patient to have a vaginal birth after a caesarian section (VBAC) because of increasing complications. The incidence of CS in Indonesia has been growing over the past year. In addition, several studies have shown an increased risk of problems in subsequent pregnancies in mothers with a history of cesarean section. Thus, VBAC in two previous scars becomes an alternative choice for a certain patient. Case Illustration: We reported three cases of TOLAC; Three of which had been planned for vaginal birth after caesarian section (VBAC) since the prenatal period Case 1: A 30-year-old woman, G3P2, is 39 weeks pregnant and has had two previous cesarean sections. Cardiotocography was normal. The patient was closely monitoring the signs of uterine rupture during labor, and after 7 hours, she had a successful VBAC without complication. A female baby weighting 4000g was born, both mother and child were in good health condition. Case 2: A 38-year-old woman, G6P4A1, is 41 weeks pregnant has had two previous vaginal deliveries, and has had two previous caesarian section prior to this pregnancy. The patient was closely monitored for vital signs and signs of uterine rupture. Cardiotocography is normal. She had a successful VBAC without complications after eight hours and delivered a male baby with a body weight of 3500g and good APGAR CSore. Case 3: A 35-year-old woman, G3P2A0, had two previous CS admitted at 39 in the latent phase of labor with a cervical dilatation of 2 cm. The labor progressed to the second stage after nine hours. After an hour attempted to conduct delivery, the fetus was still not delivered. Catheterization was performed, which revealed hematuria and proceeded with emergency caesarian section due to suspect a uterine rupture. Intraoperatively, the uterine rupture was noted at the lower anterior of the uterine corpus, measuring 2x1 cm and a repair was performed. Conclusion: VBAC can be considered in patients two previous c-sections with after proper selection, close monitoring and adequate counseling. Prenatal care is a concern for pregnant women to prevent complications and reduce maternal and fetal morbidity and mortality. The VBAC decision returned to personalization and adequate assessment and counseling are mandatory.