https://orcid.org/0000-0003-4630-4854
Abstract
Purpose
We sought to determine the success rate of VBAC and factors associated with achieving VBAC at a referral hospital in the Democratic Republic of Congo in women with a subsequent pregnancy greater than or equal to 18 months from their primary cesarean section (CS).
Patients and Methods
Patients were included for participation if they had an inter-delivery interval (IDI) of at least 18 months from their primary CS, accepted TOLAC, and had no contraindications. Information was collected about patients’ demographics, obstetric history, and factors impacting their labor process. Descriptive analyses compared patients that had a successful VBAC and those who did not. Univariate and multivariate binary logistic regression models identified factors associated with a successful VBAC.
Results
Among 231 eligible patients who attempted a VBAC, 57.6% (133) achieved VBAC. Participants had a mean age of 29 (SD 6), with the majority having a prior vaginal delivery (68.8%). VBAC was positively associated with a higher Bishop score (AOR 1.12, 95% CI 1.02, 1.23) and a spontaneous labor onset (AOR 3.06, 95% CI 1.52, 6.17). VBAC was negatively associated with a macrosomic fetus (AOR 0.21, 95% CI 0.08, 0.58).
Conclusion
TOLAC results in VBAC more than half the time and is associated with a spontaneous labor onset and a higher Bishop score. Women with a macrosomic fetus were more likely to have an unsuccessful VBAC, resulting in an RCS. An optimal IDI was not enough to ensure a successful VBAC. Upon patients’ arrival to the hospital, practitioners should re-evaluate their eligibility to attempt a VBAC based on their Bishop score and if they had a spontaneous labor onset to decrease the health risks of an RCS.
Abbreviations
AOR, adjusted odds ratio; BMI, body mass index; CI, confidence interval; m, meter; CS, cesarean section; DRC, Democratic Republic of Congo; kg, kilogram; IDI, inter-delivery interval; IQR, inter-quartile range; OR, odds ratio; RCS, repeat cesarean section; SD, standard deviation; SPSS, Statistical Package for Social Science; TOL, trial of labor; TOLAC, trial of labor after cesarean; VBAC, vaginal birth after cesarean.
Acknowledgments
The authors acknowledge the medical staff and patients for participating in this study. We especially thank Dr. Heidi W. Brown for her contribution to this manuscript.
Author Contributions
All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis, and interpretation, or in all of these areas; took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; agreed on the journal to which the article has been submitted, and agree to be accountable for all aspects of the work.
Disclosure
The authors report no conflicts of interest in this work.