Background: The rising rates of cesarean sections (CS) globally have increased the number of women with prior cesarean deliveries who may be candidates for vaginal birth after cesarean (VBAC). This study explores the factors influencing the success of VBAC in women with a previous CS and fetomaternal complications associated with VBAC failure. Methods: This cross-sectional study was conducted at the obstetrics unit of Ayub Teaching Hospital, Abbottabad, Pakistan, enrolling 102 eligible women who had previously undergone a CS and were offered the option of attempting a vaginal delivery. Demographic, clinical, and obstetric data were collected on a predesigned proforma. The success of VBAC was defined as a vaginal delivery without the need for an emergency cesarean section. Statistical analysis was done using IBM SPSS Statistics software, version 27.0 (IBM Corp., Armonk, NY). Results: Participants had a mean age of 30.36 ± 2.07 years and a mean body mass index (BMI) of 25.71 ± 0.90 kg/m². The overall VBAC success rate was 79.4% (n=81), with a failure rate of 20.6% (n=21). Maternal complications, including infection and the need for blood transfusion, were significantly higher in the VBAC failure group. Fetal outcomes also showed that VBAC failures were more likely to result in an Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score <7 at 10 minutes (P=0.006). Similarly, maternal complications were significantly higher in VBAC failures (5/21, 23.8%) than successes (3/81, 3.7%; P=0.009). On regression analysis, VBAC failure was found to be an independent predictor of both fetal complications (with an odds ratio of 14.610 (95% CI: 1.290-165.421, p = 0.030)) and maternal complications (with an odds ratio of 8.767 (95% CI: 1.762-44.535, p = 0.009)). Conclusions: VBAC is a safe and effective option for women with a prior CS, with a high success rate; however, VBAC failure was found to be an independent predictor of both fetal and maternal complications. Our findings suggest the importance of a personalized approach to VBAC assessment and counselling to optimize outcomes for women undergoing trial of labor after cesarean (TOLAC).
Rahman et al. (Fri,) studied this question.