Vaginal Birth After Caesarean Section– A 5 Year Review in A Tertiary Hospital in South-West Nigeria

Abstract

ABSTRACT

Background

Vaginal birth after Caesarean section (VBAC) is an option of delivery that allows women who had undergone Lower Segment Caesarean section (LSCS) have vaginal deliveries and this option is considered safe in selected cases. However, it is observed that the rate of VBAC has decreased during the past 10 years, having a global rate of 10% as at 2005 compared to 40-50% rate of 1996. Nevertheless, VBAC, despite the known risks, 0.5-0.9% risk of uterine rupture, remains an attractive option for many patients and leads to a successful outcome in a high proportion of cases. VBAC is preferred to Elective Repeat Caesarean Delivery (ERCD) especially in women with one previous lower segment caesarean section. The success of VBAC is dependent on some VBAC predictive factors which include non-recurring indications of the previous CS, previous vaginal delivery or previous VBAC, cervical dilatation as at presentation, birthweight, inter-delivery intervals etc. With careful patient selection and good management of labour, it has been documented that a high success rate for vaginal birth after caesarean section (VBAC) can be achieved.

Objectives

This study was carried out to determine the incidence, success rate, predictive factors, and the outcome of Vaginal Birth after Caesarean Section (VBAC) at the University College Hospital (UCH), Ibadan, Nigeria.

Methods

This was a retrospective descriptive study analysing case records of all women who had VBAC between 1^st January, 2016 and 31^st December, 2020 at the University College Hospital (UCH), Ibadan, Nigeria. The data collected were analysed using a Statistical Product and Service Solution (SPSS) version 25. The dependent variable was successful VBAC which was binary in nature. The incidence rate of VBAC (VBAC rate) was determined from all the first Caesarean deliveries that occurred in the 5-year period and the proportion of successful VBAC calculated from the total number of women who were planned for VBAC. Descriptive statistics were used for variable, Pearson’s Chi square or the Fisher’s exact test and Independent Students’ t-test compared, as applicable, across groups for categorical and continuous data and a p-value of < 0.05 interpreted as a statistically significant correlation. Binary logistic regression analyses examined for associations between successful VBAC and the significant independent variables.

Results

There was a total of 9,559 deliveries during the studied period, of which 4,887 were Caesarean deliveries which puts the caesarean section rate (CSR) at UCH over the 5year period at 51.12%. There were 1,084 cases of first lower segment caesarean delivery. There were 162 women that presented for VBAC out of which 116 (71.6%) were planned for VBAC while 46 (28.4%) had no prior VBAC plan. The VBAC rate (number of VBAC out of the total number who had a previous CS) was 5.9% while the VBAC success rate was 50%. There was no maternal mortality associated with VBAC in the study while the perinatal mortality rate was 12.3 per 1000 birth. Being planned for VBAC by the Obstetrician, “previous vaginal delivery”, “previous VBAC” and “Bishop Score” of ≥7 at admission for delivery were the significant predictive factors associated with successful VBAC with p-values of 0.002, <0.001, <0.001 and <0.001 respectively.

Conclusion

This study showed that the VBAC rate and success rate in our centre are relatively low, and the figures can be improved by paying more attention to the positive predictive factors of a successful VBAC and instituting more health education and awareness about VBAC.