الملخص

Background A Trial of labor after cesarean section is an attempt to deliver vaginally by a woman who had a previous cesarean delivery and when achieved by a vaginal delivery it is called successful vaginal birth after cesarean section. Vaginal birth after a caesarian section is a preferred method to decrease complications associated with repeated caesarian section delivery for both mother and fetus.

 Study Objectives To identify factors associated with successful VBAC following TOLAC in women with one prior caesarean section at Al- Gomhory Teaching Hospital.

Study Design Hospital _based retrospective study

Methods and subjects This study was conducted at Al- Gomhory Teaching Hospital, Taiz Governorate from January2023 to December 2024. A questionnaire was developed for this study, collecting data on each woman who had undergone a previous cesarean section and attempted vaginal birth, such as maternal age, interval between births, prenatal care, and fetal condition, cervical dilation at admission, mode of delivery, maternal complications, and fetal / neonatal complications. All these data were recorded, entered into SPSS software, and analyzed.

Results

There were 150 women underwent attempted vaginal birth after one cesarean section. Their mean age was 28.3 ± 6.1 years, and the mean interval between births was 4.03 ± 3.0 years. 34% of women had interdelivery interval ≤ 2 years, and 66% were over 2 years. 47.3% of women attended prenatal care, while 52.7% did not attend prenatal care. There were 22% of women experienced vaginal birth before cesarean, and 28.7% experienced vaginal birth after cesarean. The mean gestational age at delivery was 38.17 ± 3.05 weeks. There were 82.7% of women had cervical dilated (more than 4 cm), and 17.3% were less than 4 cm at admission. The success rate of vaginal birth was 64%, and the failure rate was 36%. The mean birth weight was 2994.7 ± 430.1 grams. The Apgar score at five-minute ≥ 7 88%, and the complications for newborns were admission to the intensive care unit for 13.3%, while for mothers the complications were uterine rupture for 6.7%, and the study did not record a significant relationship between ante natal health care during pregnancy and rupture of amniotic fluid membranes (P > 0.05).

Conclusion

The success rate of VBAC trials of women with previous one scare was 64% in line with global rate. Maternal age between 20-30 years, interdelivery interval > 2 years and women not booked during the current pregnancy were the predominant in our sample size. Almost half of women had previous vaginal delivery either pre or post cesarean section. Gestational age was predominant at term while, the preterm and post term were present in a small proportion of women. A Small proportion of neonates had low birth weight, had low Apgar score at 5 minutes, and admission to NICU were the common fetal outcome. Post-partum hemorrhage and uterine dehiscence were mainly the maternal outcome with high rate of uterine rupture.