Reasons for previous Cesarean deliveries impact a woman’s independent decision of delivery mode and the success of trial of labor after Cesarean

Abstract

Background: Cesarean delivery rates are increasing globally with almost half of them occurring due to a previous Cesarean delivery. A trial of labor after Cesarean (TOLAC) is considered a safe procedure, but most eligible women instead undergo Cesarean before 39 weeks of gestation. Lack of education about TOLAC is often associated with increased repeat Cesarean. To reveal the safety and feasibility of TOLAC, we conducted this observational, prospective study with women's independent decisions. We aimed to clarify the relationship between their chosen mode of delivery and the reason for their previous Cesarean. Additionally, we have tried to identify maternal and obstetric factors associated with failed TOLAC to improve its success rate. Methods: This was a prospective, observational study of 1086 pregnant women with at least one previous Cesarean delivery. Of these, 735 women met our TOLAC criteria (Table 1), and then, could choose TOLAC or repeat Cesarean after receiving detailed explanations regarding the risks and benefits of both procedures. The primary outcomes were the number of successful TOLAC procedures and 5-min Apgar scores < 7 for the trial of labor after Cesarean group and elective Cesarean group. We collected the maternal and neonatal data including the reasons of previous Cesarean. Results: In total, 64.1% of women chose TOLAC. The success rate was 91.3%. The uterine rupture rate was 0.6%. There were no significant differences in the rate of Apgar scores at 5 min < 7 between both groups. Histories of experience of labor in previous Cesarean delivery were observed in 30 and 50% of women who chose TOLAC and repeat Cesarean, respectively (p < 0.05). Factors related to failed TOLAC included ≥40 weeks of gestation (odds: 5.47, 95% CI: 2.55-11.70) and prelabor rupture of membranes (PROM) (odds: 4.47, 95% CI: 2.07-9.63).Conclusions: TOLAC is a favorable delivery option for both mothers and neonates when women meet criteria and choose after receiving detailed explanations. Women who experience PROM or ≥ 40 weeks of gestation, their modes of delivery should be reconsulted.

Indications and factors associated with cesarean section in Bhutan: A hospital‐based study

“…Repeat CS is not indicated for all women with previous CS in the subsequent pregnancies and vaginal birth after CS (VBAC) can be encouraged, especially in centers equipped with obstetricians. Studies in some countries have shown that VBAC has a success rate of 91.3%, 15 especially in women who underwent vaginal birth before CS and for whom fetal malpresentation was the indications for a previous CS. Usually VBAC is associated with lower morbidity compared with repeat CS.…”

“…Studies in some countries have shown that VBAC has a success rate of 91.3%,15 especially in women who underwent vaginal birth before CS and for whom fetal malpresentation was the indications for a previous CS. Usually VBAC is associated with lower morbidity compared with repeat CS.…”

Vaginal delivery after caesarean section and its associated factors in Mizan Tepi University Teaching Hospital, Southwest Ethiopia

“…The proposed rates of successful VBAC have been reported to be 60-80% [9,10,11]. However, the VBAC success rate is lower in Africa including Ethiopia [12,13,14].…”

“…However, the VBAC success rate is lower in Africa including Ethiopia [12,13,14]. For example successful VBAC was 48% in Nigeria [12], 48% in Ghana [14], and 45.5% in Ethiopia [13] Although successful VBAC is a safer and a more recommended method for women with previous single caesarean section delivery than undergoing elective repeat caesarean delivery [15], the chance of successful VBAC is determined by factors such as history of previous vaginal delivery, cervical dilatation and station at admission, birth weight >4 kg, cephalo-pelvic disproportion, and maternal age [8,15]; Studies revealed that previous history of vaginal delivery is the best predictor of VBAC success [11,13,14].…”

Previous mode of delivery affects subsequent pregnancy outcomes: a Chinese birth register study

“…According to an analysis on the ways and outcomes of childbirth in Asia published in 2010 (7), cesarean delivery increases the risk of maternal death, admission to the ICU, blood transfusion, hysterectomy, and iliac artery ligation. Pregnant women with a history of cesarean delivery, irrespective of whether they choose a cesarean or vaginal delivery at the present, are at a higher risk of developing complications than those who had a normal vaginal delivery the first time, including serious adverse events such as uterine rupture and maternal and neonatal death (8,9). Complications related to the placenta are among the more serious consequences of previous CS (10).…”