Delivery outcome and predictors of successful vaginal birth after primary cesarean delivery: A comparative study

Abstract

Objectives: This study aimed to determine the rate and predictive factors for successful vaginal birth after cesarean delivery, and measure maternal and neonatal outcomes of VBAC following one previous cesarean delivery. Methods: In this hospital-based prospective study, sixty women with one previous CD (subjects) who attempted VBAC and another sixty without previous CD (controls) carrying singleton cephalic fetuses matched for maternal age, parity, and gestational age were compared. The primary outcome measures were successful vaginal delivery and its predictors. Data were analyzed using SPSS (version 22.0), and p<0.05 was significant. Results: Out of 1768 deliveries, 105 (5.9%) had one previous CD; 57.1% (60/105) attempted while 61.7% (37/60) had successful VBAC; 23 (38.3%) had failed VBAC and repeat CD, while 14 (23.3%) of the control group had CD. The significant predictors of successful VBAC were cervical dilatation ≥4cm on admission (p=0.003), maternal age >35 years (p=0.019); and augmentation of labor (p=0.020); while previous vaginal delivery (p=0.108), parity (p=0.706), BMI (0.240), and inter-delivery interval (p=0.265) were not statistically significant. The maternal and neonatal outcomes were not statistically different among women who had successful VBAC after one CD compared to women without previous CD. Important morbidities following VBAC included uterine rupture (3.3%) and primary postpartum hemorrhage (6.7%). There was no peripartum hysterectomy or maternal death; the perinatal mortality rate was 16.7/1,000 live births for women who attempted VBAC while no perinatal death was recorded among the controls. Conclusion: VBAC is safe, and its outcome is comparable to women without previous CD.