Vaginal Birth after One Caesarean Section in Women who had Spontaneous Labour: Review of Practice and Evaluation of Predictive Scores in a Resource Constrained Setting in Nigeria

Aims: To evaluate and determine the practice, outcome, success rate, complications and predictive factors of vaginal birth after one Caesarean section (VABC) in spontaneous labour.

Study Design: A retrospective study.

Place and Duration of Study: Department of Obstetrics and Gynaecology of Ekiti State University Teaching Hospital, Ado-Ekiti, between January 2010 and December 2014.

Methodology: The case files of women who had one previous lower segment Caesarean section and were managed in spontaneous active phase of labour between the gestational age of 28 and 41 weeks were retrieved from the medical records department for analysis. Specific sociodemographic variables, intrapartum complications, route of delivery and other materno–fetal outcome variables (to identify predictors of a successful VBAC) were extracted from the case notes. Analysis was done using Chi square or the Fisher’s exact test and t test while logistic regression was done to determine the predictors of successful VBAC using odd ratios and 95% confidence interval.

Results: Out of 727 women selected for VBAC, 388 (53.4%) had successful vaginal delivery. Previous vaginal delivery, previous successful vaginal birth after Caesarean section, and cervical dilatation of more than 7cm when the previous Caesarean section was done were the significant predictive factors associated with successful vaginal birth after one Caesarean section, P = 0.01 while the age of the women and weight of the babies at birth, P = 0.43 & 0.82, were not significantly associated with successful vaginal birth after Caesarean section. There were no cases of uterine rupture, perinatal and maternal mortality recorded in women who had VBAC during the period of the review.

Conclusion: This study has demonstrated that when patients are carefully selected using the positive predictive factors, trial of VBAC is a possibility in low resource settings with minimal facilities for monitoring.