Outcomes in women attempting vaginal birth after caesarean section, and in their babies, at two tertiary institutions

Abstract

Objectives: To determine the maternal and perinatal outcomes of vaginal delivery in pregnant women with one previous caesarean section. 

Study Design: This was a prospective cohort design.

Setting: The study was conducted at Mbuya Nehanda and Harare Central Hospital Maternity Units.

Subjects: Three hundred and eighty (380) pregnant women were recruited using consecutive sampling and 351 were available for final analysis. Eligible women had a single lower segment caesarean section, a gestational age ≥ 37 weeks, singleton pregnancy with a cephalic presentation and were willing to participate.

Main Outcome Measures: Main outcome factors was maternal and perinatal mortality and morbidity

Results: One hundred and twenty eight women (36.5%) had elective repeat caesarean section and 223 (63.5%) attempted vaginal delivery. There were neither maternal deaths nor perinatal mortality. 51.1% of those who attempted vaginal delivery were successful. Previous vaginal deliveries, a height above 162.8cm, higher parity and longer interval from previous caesarean section were significantly associated with successful vaginal delivery. A successful vaginal delivery was associated with lower NICU admissions and higher APGAR scores in the neonate than those delivered by caesarean section but there was no statistically significant difference between the groups for APGAR scores <7. There were 3 cases of uterine rupture discovered at caesarean section but these were not associated with maternal or perinatal mortality.

Conclusion: Attempting vaginal delivery is safe and should be continued to be offered to properly selected women with a single previous caesarean section. There was a low rate of maternal and foetal complications.