Outcome of Trial of Labor after Cesarean Delivery: Evaluating the Flamm Scoring System in Two Hospitals in Cameroon: A 5-year Retrospective Study

Abstract

Background: Outcomes of trial of scar (TOS) correlate well with predictions provided by vaginal birth after cesarean scoring systems. In Cameroon, there is limited data on the implementation and effectiveness of these scoring systems, as well as the materno-fetal outcomes of TOS. Objectives: The objective was to utilize the Flamm score in predicting the success of TOS, and to evaluate the maternal and fetal outcomes observed following TOS in Yaounde and Douala Gyneco-Obstetric and Pediatric Hospitals from 2017 to 2021. Material and Methods: We included files of 310 parturient women with single transverse lower uterine segment cesarean section, who had TOS. Data on sociodemographic, reproductive health, Flamm scoring, and labor outcomes were documented using a structured data extraction form and analyzed using the Statistical Package for the Social Sciences version 25. Results: Of the 310 patients, 73.9% had successful vaginal deliveries (VDs) and 26.1% had repeated emergency cesarean. Flamm score predictions were associated with TOS outcomes (P = 0.0001), with mean score of 5.87 ± 0.01 for successful VD compared to 3.72 ± 0.126 for repeat cesarean. Probability of successful VD increased with Flamm score, ranging from 0% for scores of two to 100% for scores > 7, with a cutoff score of 4.5 (Se = 75.0%, Sp = 75.3%). The main maternal complication was one uterine rupture (0.32%) and neonatal complications were three stillbirths (0.98%) and one early neonatal death (0.32%) after repeat cesarean. Conclusions: TOS is associated with high success rates in tertiary hospitals in Cameroon. Applying Flamm score will improve the chances of a successful VD following TOS, and should be encouraged.