Predictors of successful vaginal birth after one caesarean section at selected hospitals in Lusaka, Zambia

Main Article Content

M Mukape
B Vwalika

Abstract





Background. Repeat caesarean section (CS) carries an increased risk of both maternal and neonatal morbidity and mortality. Planned vaginal birth after CS (VBAC), with an estimated success rate of 60 - 80%, is clinically safer than elective repeat CS, and also limits the rise in CSs. There is no single generalised validated tool to predict success of VBAC.


Objectives. To determine predictors of successful VBAC among mothers with one previous CS at selected hospitals in Lusaka, Zambia.


Method. Determination of independent predictors with significant high odds of a successful VBAC among mothers offered a trial of labour (TOL) was conducted in a cross-sectional study. Women with a history of one previous lower-segment CS, who were carrying a singleton fetus and were in established labour or draining amniotic fluid and scheduled for TOL after CS, were included in the study. Convenience sampling was used to enrol 290 participants. Using SPSS version 22, bivariate analysis and logistic regression analysis were used to analyse data. An independent factor associated with successful VBAC and with a p-value <0.05 was considered significant.


Results. Of the participants, 236 (81.4%) had a successful vaginal delivery and 54 (18.6%) failed to deliver vaginally and required emergency CS. Key independent predictors of success of VBAC were primary education level (adjusted odds ratio (AOR) 2.21; 95% confidence interval (CI) 1.01 - 4.84), multiparity (AOR 4.81; 95% CI 1.16 - 19.93), previous successful VBAC (AOR 9.94; 95% CI 1.29 - 76.70), inter-delivery interval after the primary CS (AOR 18.54; 95% CI 5.98 - 57.48), a history of fetal distress (AOR 9.33; 95% CI 2.48 - 35.08), malpresentation (AOR 6.13; 95% CI 1.65 - 22.70) or failed induction of labour (AOR 20.52; 95% CI 3.32 - 127.03) as indications for the primary CS, Bishop score (AOR 7.06; 95% CI 1.92 - 25.97), cervical dilation (AOR 11.62; 95% CI 3.86 - 35.03), duration of labour (AOR 20.78; 95% CI 5.62 - 76.80), birthweight (AOR 6.80; 95% CI 3.33 - 13.91) and Apgar score (AOR 28.42; 95% CI 5.67 - 142.38).


Conclusion. A combination of independent sociodemographic and obstetric factors that have significant high odds for a good outcome of VBAC could help predict success of delivery in a given population. This information could also aid in counselling mothers on mode of delivery.





Article Details

How to Cite
Predictors of successful vaginal birth after one caesarean section at selected hospitals in Lusaka, Zambia. (2024). South African Journal of Obstetrics and Gynaecology, 30(1), e2126. https://doi.org/10.7196/SAJOG.2024.v30i1.2126
Section
Research Articles
Author Biographies

M Mukape, Department of Obstetrics and Gynaecology, School of Medicine, University of Zambia, Zambia

Department of Obstetrics and Gynaecology

University of Zambia

School of Medicine

B Vwalika, Department of Obstetrics and Gynaecology, School of Medicine, University of Zambia, Zambia

Professor of Obstetrics and Gynaecology

University of Zambia

School of Medicine

Department of Obstetrics and Gynaecology

How to Cite

Predictors of successful vaginal birth after one caesarean section at selected hospitals in Lusaka, Zambia. (2024). South African Journal of Obstetrics and Gynaecology, 30(1), e2126. https://doi.org/10.7196/SAJOG.2024.v30i1.2126

References

1. ACOG Practice bulletin no. 115: Vaginal birth after previous cesarean delivery. Obstet Gynecol 2010;116(2 Pt 1):450-463. https://doi.org/10.1097/AOG.0b013e3181eeb251

2. National Institute for Health and Clinical Excellence (NICE). Caesarean section. Clinical guideline (CG132). 23 November 2011. https://www.nice.org.uk/guidance/cg132 (accessed 6 December 2024). 3. Royal College of Obstetricians and Gynaecologists. Birth after previous caesarean birth (Green-top Guideline no. 45). Last reviewed 1 October 2015. https://www.rcog.org.uk/guidance/browse-all- guidance/green-top-guidelines/birth-after-previous-caesarean-birth-green-top-guideline-no-45/

(accessed 6 December 2024).

4. ACOG practice bulletin. Vaginal birth after previous cesarean delivery. Int J Gynecol Obstet

1999;66(2):197-204. https://doi.org/10.1016/S0020-7292(99)80021-6

5. Ugwumadu A. Does the maxim ‘once a caesarean, always a caesarean’ still hold true? PLoS Med

2005;2(9):e305. https://doi.org/10.1371/journal.pmed.0020305

6. Prior cesarean delivery. In: Cunningham F, Leveno KJ, Dashe JS, Hoffman BL, Spong CY, Casey

BM. eds. Williams Obstetrics. 26th ed. McGraw-Hill, 2022: ch. 31. https://accessmedicine.

mhmedical.com/content.aspx?bookid=2977&sectionid=250396730 (accessed 6 December 2024). 7. Cook JR, Jarvis S, Knight M, Dhanjal MK. Multiple repeat caesarean section in the UK: Incidence and consequences to mother and child. A national, prospective, cohort study. BJOG

2013;120(1):85-91. https://doi.org/10.1111/1471-0528.12010

8. Marshall NE, Fu R, Guise JM. Impact of multiple cesarean deliveries on maternal morbidity:

A systematic review. Am Obstet Gynecol 2011;205(3):262.e1-8. https://doi.org/10.1016/j.

ajog.2011.06.035

9. Knight HE, Gurol-Urganc I, van der Meulen JH, et al. Vaginal birth after caesarean section: A cohort study investigating factors associated with its uptake and success. BJOG 2014;121(2):183- 192. https://doi.org/10.1111/1471-0528.12508

10. Shaheen N, Khalil S, Iftikhar P. Prediction of successful trial of labour in patients with a previous caesarean section. J Pak Med Assoc 2014;64(5):542-545.

11. Wen J, Song X, Ding H, et al. Prediction of vaginal birth after cesarean delivery in Chinese parturients. Sci Rep 2018;8(1):3084. https://doi.org/10.1038/s41598-018-21488-6

12. Boulvain M, Fraser WD, Brisson-Carroll G, Faron G, Wollast E. Trial of labour after caesarean section in sub-Saharan Africa: A meta-analysis. Br J Obstet Gynaecol 1997;104(12):1385-1390. https://doi.org/10.1111/j.1471-0528.1997.tb11008.x

13. Mulindi M. Outcome of labour following one previous ceaserean section at the University Teaching Hospital in Lusaka, 1 October 1995 - 30 September 1996, Lusaka: African Digital Health Library, 1999. https://library.adhl.africa/handle/123456789/12982 (accessed 6 December 2024).

14. Bashir JA, Noureldin K, Ellhassan MAY, Abdelwahid MA, Handady MOS. Factors associated with success rate of vaginal birth after one caesarean section (VBAC) in Ibrahim Malik Teaching Hospital, Khartoum-Sudan. Austin J Obstet Gynecol 2018;5(9):1129.

15. Maurya A, Manik A. Study of factors associated with success of vaginal birth after previous one caesarean section. Sch J App Med Sci 2016;4(1C):210-213. https://doi.org/10.36347/sjams.2016. v04i01.039

16. Srinivas SK, Stamilio DM, Sammel MD, et al. Vaginal birth after caesarean delivery: Does maternal age affect safety and success? Paediatr Perinat Epidemiol 2007;21(2):114-120. https://doi. org/10.1111/j.1365-3016.2007.00794.x

17. Wu Y, Kataria Y, Wang Z, Ming WK, Ellervik C. Factors associated with successful vaginal birth after a cesarean section: A systematic review and meta-analysis. BMC Pregnancy Childbirth 2019;19(1):360. https://doi.org/10.1186/s12884-019-2517-y

18. Balachandran L, Vaswani PR, Mogotlane R. Pregnancy outcome in women with previous one cesarean section. J Clin Diagn Res 2014;8(2):99-102. https://doi.org/10.7860/JCDR/2014/7774.4019 19. Senturk MB, Cakmak Y, Atac H, Budak M. Factors associated with successful vaginal birth after cesarean section and outcomes in rural area of Anatolia. Int J Womens Health 2015;7:693-697.

https://doi.org/10.2147/IJWH.S83800

20. Gilbert A, Benjamin A, Abenhaim HA. Does education level influence the decision to undergo elective repeat caesarean section among women with a previous caesarean section? J Obstet Gynaecol Can 2010;32(10):942-947. https://doi.org/10.1016/s1701- 2163(16)34681-3

21. Guise JM, Eden K, Emeis C, et al. Vaginal birth after cesarean: New insights. Evid Rep Technol Assess (Full Rep) 2010;191:1-397.

22. Birara M, Gebrehiwot Y. Factors associated with success of vaginal birth after one caesarean section (VBAC) at three teaching hospitals in Addis Ababa, Ethiopia: A case control study. BMC Pregnancy Childbirth 2013;13:31. https://doi.org/10.1186/1471-2393-13-31

23. Cecatti JG, Pires HMB, Faúndes A, Duarte Osis MJ. Factors associated with vaginal birth after previous cesarean section in Brazilian women. Rev Panam Salud Publica 2005;18(2):107-113. https://doi.org/10.1590/s1020-49892005000700005

24. Mercer BM, Gilbert S, Landon MB, et al. Labour outcomes with increasing number of prior vaginal births after cesarean delivery. Obstet Gynecol 2008;111(2 Pt 1):285-291. https://doi.org/10.1097/ AOG.0b013e31816102b9

25. Kalok A, Zabil SA, Jamil MA, et al. Antenatal scoring system in predicting the success of planned vaginal birth following one previous caesarean section. J Obstet Gynaecol 2018;38(3):339-343. https://doi.org/10.1080/01443615.2017.1355896

26. Flamm BL, Newman LA, Thomas SJ, Fallon D, Yoshida MM. Vaginal birth after caesarean delivery: Results of a 5-year multicenter collaborative study. Obstet Gynecol 1990;76(5 Pt 1):750-754. https:// doi.org/10.1097/00006250-199011000-00004

27. Shakti V, Behera RC, Sandhu GS, Singh A, Bandhu HC. Vaginal birth after caesarean delivery. J Obstet Gynecol India 2006;56:320-323.

28. Durnwald C, Mercer B. Vaginal birth after caesarean delivery: Predicting success, risks of failure. J Matern Fetal Neonatal Med 2004;15(6):388-393. https://doi.org/10.1080/14767050410001724290 29. Gupta S, Jeeyaselan S, Guleria R, Gupta A. An observational study of various predictors of success of vaginal delivery following a previous cesarean section. J Obstet Gynaecol India 2014;64(4):260-

264. https://doi.org/10.1007/s13224-014-0519-2

30. Li YX, Bai Z, Long DJ, et al. Predicting the success of vaginal birth after caesarean delivery: A

retrospective cohort study in China. BMJ Open 2019;9(5):e027807. https://doi.org/10.1136/

bmjopen-2018-027807

31. Madaan M, Agrawal S, Nigam A, Aggarwal R, Trivedi SS. Trial of labour after previous caesarean section: The predictive factors affecting outcome. J Obstet Gynaecol 2011;31(3):224-228. https:// doi.org/10.3109/01443615.2010.544426

32. Landon MB, Hauth JC, Leveno KJ, et al. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. N Engl J Med 2004;351(25):2581-2589. https://doi.org/10.1056/ NEJMoa040405

33. Grylka-Baeschlin S, Clarke M, Begley C, et al. Labour characteristics of women achieving successful vaginal birth after caesarean section in three European countries. Midwifery 2019;74:36- 43. https://doi.org/10.1016/j.midw.2019.03.013

34. Bujold E, Hammoud AO, Hendler I, et al. Trial of labor in patients with previous cesarean section: Does maternal age influence outcome? Am J Obstet Gynecol 2004;190(4):1113-1118. https://doi. org/10.1016/j.ajog.2003.09.05535. Altman M, Sandström A, Petersson G, Frisell T, Cnattingius S, Stephansson O. Prolonged second stage of labor is associated with low Apgar score. Eur J Epidemiol 2015;30(11):1209-1215. https:// doi.org/10.1007/s10654-015-0043-4

36. Bekalu G, Etefa T, Asefa A, Terefe B, Dereje D. Determinants of low fifth minute Apgar score among newborn delivered in Jimma University Medical Center, Southwest Ethiopia. Int J Pediatr 2020;2020:9896127. https://doi.org/10.1155/2020/9896127

37. Gudayu TW. Proportion and factors associated with low fifth minute Apgar score among singleton newborn babies in Gondar University Referral Hospital; North West Ethiopia. Afr Health Sci 2017;17(1):1-6. https://doi.org/10.4314/ahs.v17i1.2

38. Salustiano EMA, Campos JADB, Ibidi SM, Ruano R, Zugaib M. Baixos indices de Apgar no quinto minuto de vida em populaçao de baixo risco: Fatores maternos e obstetricos e resultados pos-natais [Low Apgar scores at 5 minutes in a low risk population: Maternal and obstetrical factors and postnatal outcome]. Rev Assoc Med Bras 2012;58(5):587-593. https://doi.org/10.1590/ S0104-42302012000500017