Trial of Vaginal Delivery after Previous Caesarean Section

Original Article


Yousef Bashir Gadmour ¹, Fathia Ali Godid ²

1-Department of Obstetrics & Gynaecology, Faculty of Medicine, Al-Fateh University, Tripoli, Libya. 2- Department of Obstetrics and Gynaecology, Zawia Teaching Hospital Zawia, Libya.

JMJ 2009,Vol.9, No.1: 36-40


Objective: The purpose of this study is to determine which factors influence the likelihood of successful trial of labour (TOL) after one previous caesarean delivery (C/D ), and determine its complication rate. Setting: Zawia Teaching Hospital, Zawia city, Libya. Design: An observational retrospective cohort study. Patients Method and Material: The study was conducted from April 2005 to April 2006, 434 were underwent (TOL), and the other 64 women were dropped from the study because they were delivered by an elective caesarean section. This retrospective study included all women with singleton or multiple gestation of at least 37 weeks gestation, past obstetric history, including indication of the previous (C/D), history of previous vaginal delivery or vaginal birth after caesarean (VBAC) and presence of maternal diseases were recorded. Obstetric factors related to the present pregnancy include birth weight, gestational age, foetus gender, type of labour, cervical dilation on admission and at the time of decision for (C/D) and duration of the first stage of labour. Complications of cases which attempted (VBAC) were recorded. Complications which developed in women who underwent C/D were also recorded. Results: Four hundred and thirty four women with previous one (C/D) underwent (TOL), 221 (50.9 %) achieved successful VBAC. One hundred and nine women with previous VBAC had the highest success rate (84.5%) compared with 38 (30.2%) women without such a history. One hundred forty seven women with previous vaginal delivery had high success rate of (65.9%) compared with (33.4 %) in 74 women who did not have such history. TOL success rates were affected by previous indication for C/D. The success rates were as follow; (55.4%) when malpresentation was a the previous indication, spontaneous labour (53.7%) , cervical dilation > 4 cm on admission (71.9%), birth weight < 4000 gm (69.8%) and gestational age 37-40 weeks (69.6%). Totally the women, who attempted (VBAC) experienced less complications than who failed TOL (3.6%, 17.8%) respectively. Conclusion: Previous caesarean delivery is still a warning condition, it is considered a high risk case in the obstetric field, due to the risk of 0.5 - 1% of uterine repture. A trial of labour after caesarean delivery remains an attractive option for many patients and leads to a successful outcome in a high proportion of cases. In comparison, the alternative of elective repeat caesarean delivery is not without risks.There are indicators of successful TOL previous vaginal delivery and previous VBAC were found to be the most significant predicator of VBAC success. Cervical dilation and ripping at onset of labour, spontaneous onset of labour, last caesarean delivery more than two years, indication of previous C/D not dystocia, good foeto- maternal condition, were other important indicators of success of trial of labour. Keywords: Trial of labour (TOL), Previous caesarean delivery (C/D), Vaginal birth after caesarean (VBAC). Link/DOI: