Various Modes of Delivery After a Trial of Labor among Pregnant Women at Term with a Previous One Cesarean Section
Labor among Pregnant Women at Term with a Previous Cesarean Section
DOI:
https://doi.org/10.54393/pjhs.v7i4.3766Keywords:
Vaginal Birth After Cesarean, Trial of Labor After Cesarean, Cesarean Section, Repeat Cesarean Delivery, Mode of Delivery, Maternal Outcomes, Labor Management, Parity, Body Mass Index, Obstetric PracticeAbstract
The most crucial approach to lowering the increasing prevalence of cesarean sections and related maternal morbidity is vaginal birth after cesarean (VBAC). The need for local evidence to direct clinical practice is highlighted by the fact that TOLAC success varies across populations. Objectives: To identify the rates of various delivery modalities: spontaneous VBAC, assisted VBAC, and repeat cesarean section among women who have undergone a trial of labor following one prior cesarean section and relate them to age, BMI, and parity. Methods: This study was conducted in the Department of Gynecology at Mohtarma Benazir Bhutto Shaheed Medical College/DHQ Teaching Hospital, Mirpur, Azad Kashmir. It was a descriptive cross-sectional study conducted over 6 months. The sample size was 160 with full-term pregnant women with one prior c-section. Consecutive sampling was applied for this study. Data were analyzed using SPSS version 25.0 with a chi-square test (p<0.05). Results: Spontaneous VBAC occurred in 57.5% of women, assisted VBAC in 20.6%, and repeat cesarean in 21.9%. Assisted VBAC was significantly associated with age ≥30 years (p=0.030) and parity (p=0.026), while spontaneous VBAC was significantly related to BMI (p = 0.041). Conclusions: The VBAC success rate was 78.1%, indicating that TOLAC is a safe and effective option for most women with one previous cesarean section. Although age, BMI, and parity influenced modes of vaginal delivery, they did not significantly affect repeat cesarean rates, supporting planned TOLAC to reduce unnecessary repeat cesarean sections and improve maternal outcomes.
References
Chen X and Mi MY. The Impact of a Trial of Labor After Cesarean Versus Elective Repeat Cesarean Delivery: A Meta-Analysis. Medicine. 2024 Feb; 103(7): e37156. doi: 10.1097/MD.0000000000037156. DOI: https://doi.org/10.1097/MD.0000000000037156
Davis D, Homer CS, Clack D, Turkmani S, Foureur M. Choosing Vaginal Birth After Caesarean Section: Motivating Factors. Midwifery. 2020 Sep; 88: 102766. doi: 10.1016/j.midw.2020.102766. DOI: https://doi.org/10.1016/j.midw.2020.102766
Kaimal AJ, Grobman WA, Bryant AS, Norrell L, Bermingham Y, Altshuler A et al. Women's Preferences Regarding the Processes and Outcomes of Trial of Labor After Cesarean and Elective Repeat Cesarean Delivery. Journal of Women's Health. 2019 Aug; 28(8): 1143-52. doi: 10.1089/jwh.2018.7362. DOI: https://doi.org/10.1089/jwh.2018.7362
Sys D, Kajdy A, Baranowska B, Tataj‐Puzyna U, Gotlib J, Bączek G et al. Women's Views of Birth After Cesarean Section. Journal of Obstetrics and Gynaecology Research. 2021 Dec; 47(12): 4270-9. doi: 10.1111/jog.15056. DOI: https://doi.org/10.1111/jog.15056
Hautakangas TM, Uotila JT, Huhtala HS, Palomäki OL. How Does Uterine Contractile Activity Affect the Success of Trial of Labour After Caesarean Section, and the Risk of Uterine Rupture? An Exploratory, Blinded Analysis of a Cohort from a Randomized Controlled Trial. An International Journal of Obstetrics and Gynaecology. 2022 May; 129(6): 976-84. doi: 10.1111/1471-0528.17005. DOI: https://doi.org/10.1111/1471-0528.17005
Gitas G, Alkatout I, Ertan KA, Rody A, Proppe L, Kocaer M et al. Risk Factor Analysis in Women Who Underwent Trial of Labor After Cesarean Section: A Multicenter Study in Germany. Journal of the Turkish German Gynecological Association. 2022 Sep; 23(3): 137. doi: 10.4274/jtgga.galenos.2022.2022-1-2. DOI: https://doi.org/10.4274/jtgga.galenos.2022.2022-1-2
Pirhonen J and Erkkola R. Delivery After Fetal Death in Women with Earlier Cesarean Section. A Review. European Journal of Obstetrics and Gynecology and Reproductive Biology. 2021 May; 260: 150-3. doi: 10.1016/j.ejogrb.2021.03.027. DOI: https://doi.org/10.1016/j.ejogrb.2021.03.027
Patel S, Kansara V, Patel R, Anand N. Obstetric and Perinatal Outcome in Previous One Cesarean Section. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2016 Sep; 5(9): 3141-6. doi: 10.18203/2320-1770.ijrcog20163002. DOI: https://doi.org/10.18203/2320-1770.ijrcog20163002
Ooba H, Maki J, Masuyama H. Evaluating the Impact of a Trial of Labor After Cesarean Section on Labor Duration: A Retrospective Cohort Study. BioMed Central Pregnancy and Childbirth. 2024 Aug; 24(1): 542. doi: 10.1186/s12884-024-06744-0. DOI: https://doi.org/10.1186/s12884-024-06744-0
He X, Dai Q, Wu X, Zhou J, Li J. Outcomes and Risk Factors for Failed Trial of Labor After Cesarean Delivery (TOLAC) in Women with One Previous Cesarean Section: A Chinese Population-Based Study. BioMed Central Pregnancy and Childbirth. 2022 Sep; 22(1): 676. doi: 10.1186/s12884-022-05005-2. DOI: https://doi.org/10.1186/s12884-022-05005-2
Uno K, Mayama M, Yoshihara M, Takeda T, Tano S, Suzuki T et al. Reasons for Previous Cesarean Deliveries Impact a Woman’s Independent Decision of Delivery Mode and the Success of Trial of Labor After Cesarean. BioMed Central Pregnancy and Childbirth. 2020 Mar; 20(1): 170. doi: 10.1186/s12884-020-2833-2. DOI: https://doi.org/10.1186/s12884-020-2833-2
Wagaw AC, Sendekie AK, Nigatu SG, Mihretie GS. Preferred Mode of Delivery and Its Associated Factors in Pregnant Women with a Previous Cesarean Scar at a Tertiary Care Hospital in Ethiopia: Institutional-Based Cross-Sectional Study. BioMed Central Pregnancy and Childbirth. 2023 Aug; 23(1): 585. doi: 10.1186/s12884-023-05891-0. DOI: https://doi.org/10.1186/s12884-023-05891-0
Parslow E and Rayment-Jones H. Birth Outcomes for Women Planning Vaginal Birth After Caesarean (VBAC) In Midwifery Led Settings: A Systematic Review and Meta-Analysis. Midwifery. 2024 Dec; 139: 104168. doi: 10.1016/j.midw.2024.104168. DOI: https://doi.org/10.1016/j.midw.2024.104168
Rouzi AA, Alamoudi R, Ghazali S, Almansouri N, Kafy A, Alrumaihi M et al. A Retrospective Study of the Association of Repeated Attempts at Trial of Labor After Cesarean Birth on Maternal and Neonatal Outcomes. International Journal of Women's Health. 2021 Nov: 1081-6. doi: 10.2147/IJWH.S334617. DOI: https://doi.org/10.2147/IJWH.S334617
Germano C, Mappa I, Cromi A, Busato E, Incerti M, Lojacono A et al. Induction of Labor in Women with Previous Cesarean Section and Unfavorable Cervix: A Retrospective Cohort Study. In Healthcare. 2023 Feb; 11(4): 543. doi: 10.3390/healthcare11040543. DOI: https://doi.org/10.3390/healthcare11040543
Deshmukh U, Denoble AE, Son M. Trial of Labor After Cesarean, Vaginal Birth After Cesarean, and the Risk of Uterine Rupture: An Expert Review. American Journal of Obstetrics and Gynecology. 2024 Mar; 230(3): S783-803. doi: 10.1016/j.ajog.2022.10.030. DOI: https://doi.org/10.1016/j.ajog.2022.10.030
Ferede YA, Habitu YA, Tassew WC, Bitew DA. Prevalence of Successful Vaginal Birth After Caesarean Section and Its Associated Factors among Women Delivered in the University of Gondar Comprehensive Specialized Referral Hospital, Northwest Ethiopia. Contraception and Reproductive Medicine. 2025 Apr; 10(1): 29. doi: 10.1186/s40834-025-00360-9. DOI: https://doi.org/10.1186/s40834-025-00360-9
Tesfahun TD, Awoke AM, Kefale MM, Balcha WF, Nega AT, Gezahegn TW et al. Factors Associated with Successful Vaginal Birth After One Lower Uterine Transverse Cesarean Section Delivery. Scientific Reports. 2023 May; 13(1): 8871. doi: 10.1038/s41598-023-36027-1. DOI: https://doi.org/10.1038/s41598-023-36027-1
Psenkova P, Tedla M, Minarcinova L, Zahumensky J. Application of a Specific Clinical Pathway Can Affect the Choice of Trial of Labor in Patients with a History of Cesarean Delivery. BioMed Central Pregnancy and Childbirth. 2024 Apr; 24(1): 292. doi: 10.1186/s12884-024-06429-8. DOI: https://doi.org/10.1186/s12884-024-06429-8
Alkhamis F. Pregnancy Outcome in Women with Previous One Cesarean Section, Experience from the Kingdom of Saudi Arabia. The Egyptian Journal of Hospital Medicine. 2019 Oct; 77(3): 5109-13. doi: 10.21608/ejhm.2019.50257. DOI: https://doi.org/10.21608/ejhm.2019.50257
Nabawanuka B, Ngabirano T, Nankumbi J. Choice and Determinants of Delivery Mode in Pregnant Women with One Cesarean Scar: A Cross-Sectional Study in Two Urban Ugandan Public Hospitals. 2023. doi: 10.21203/rs.3.rs-3677374/v1. DOI: https://doi.org/10.21203/rs.3.rs-3677374/v1
Singh N, Pradeep Y, Jauhari S. Indications and Determinants of Cesarean Section: A Cross-Sectional Study. International Journal of Applied and Basic Medical Research. 2020 Oct; 10(4): 280-5. doi: 10.4103/ijabmr.IJABMR_3_20. DOI: https://doi.org/10.4103/ijabmr.IJABMR_3_20
Tabassum S, Suman F, Tarin AU, Rao SA. Primary Cesarean Section: A Gateway to Repeat Surgery: Primary Cesarean Section. Pakistan Journal of Health Sciences. 2025 May: 125-9. doi: 10.54393/pjhs.v6i5.2941. DOI: https://doi.org/10.54393/pjhs.v6i5.2941
İzbudak G, Tozkır E, Cogendez E, Uzun F, Eser SK. Comparison of Maternal-Neonatal Results of Vaginal Birth After Cesarean and Elective Repeat Cesarean Delivery. Ginekologia Polska. 2021; 92(4): 306-11. doi: 10.5603/GP.a2020.0132. DOI: https://doi.org/10.5603/GP.a2020.0132
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Pakistan Journal of Health Sciences
This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access journal and all the published articles / items are distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. For comments
